"Social Impact Bonds": opportunities and limits of a new model of care financing in Europe

For several months, a massive strike action is in progress. While the situation crystallizes, it appears necessary to rethink the governance of our health systems, in order to bring them in line with the new contemporary societal challenges but also with existing economic conditions: growing public debt, budget restrictions, etc...

Caregivers point out the lack of financial and human resources, and underline that budget cuts are turning the hospital into a merchant service in tension. For several decades, the superiority of private management has been invoked in the discourse and in the new public management policies, with the underlying idea of mapping the modes of operation and management of public services to that of private companies: efficiency, yield, payment to result, productivity are now at the top of the hospital's problems. Public policie priority is now to save money by concentrating the care within mega-poles, to the detriment of the small structure of proximity.