Competition for the Control of Complementary Health Insurance Reform: The Reluctance of Political and Bureaucratic Actors to Work With / For Sectorial Experts

This paper aims to examine the role of experts in the reform of complementary health insurance for local civil servants. Our intention is to identify a “reform configuration” (Bezes, 2009) where political leaders, local civil servants and peripheral experts have their own resources that allow them to influence variably the course of reform. In this changing game of interdependence, the so-called sectorial experts, whom we understand here as a set of private actors possessing knowledge on the market of social security, form alliances with the political and administrative elites to impose themselves in the decision-making process, in its implementation and in the consultations about the evolution of the reform. These experts, directly affected by the regulatory change on the aforementioned market, are of two kinds: insurance companies offering healthcare and provident contracts, and consultancy firms specialized in advising and coaching local authorities for decision-making. Based on a field survey of insurance actors, consultants, trade union representatives, human resources managers and local elected representatives, this communication aims to shed light on the resistance of administrative agents and local elected officials to work with/for sectorial experts in a context of strong economic competition. To do this, our development is divided into three parts. First of all, we will go back on the conditions that made it necessary to publicly recognize the expertise of private actors. Due to European obligations, the constrained agenda of the reform forced the State to use the knowledge and data of insurance companies and consultancy firms. Directly concerned by the regulatory change in the market, the sectorial experts were therefore judges and part of the reform. Those sectorial experts can only be directly impacted by the regulatory change in the market, and were in a position to drive and, at the same time, benefit from the reform. The options chosen have resulted in such a high level of technicity that the local implementation of supplementary health insurance requires the use of those very experts. In a second step, we will analyze the bureaucratic control of specialized knowledge in order to adapt the health and provident insurance supply to local institutional contexts. The politicization of expertise is facilitated by the great diversity in how the reform was implemented, due to both its little-restrictive nature and to the variety of local authorities in terms of size, staff composition and practice regarding social policies. This politicization can also be observed with the form of social dialogue agreed between administrative agents, local elected representatives and experts. This results in the joint formulation of policy advice. Finally, we will show that on the eve of a change in complementary health insurance policy by public authorities, a new alliance is taking place between experts, political decision-makers and administrative elites. As pointed out by cognitive approaches (Hall, 1993 ; Muller, Surel, 2000), small groups of administrative elites and/or professional associations have imposed a monopoly on expertise and, in doing so, have become key players in the reform of the healthcare system (Genieys, Smyrl, 2008).