Abstract
Over the past two decades we have witnessed an intensification in France of the role of the French government and national health insurance (Assurance Maladie) in organizing the healthcare system through the steering and oversight of public policies. In an analytical tradition that connects the role of the government as the regulator with the role of medical corporatism, this article compares the introduction of disease management and performance-based payment into the ambulatory sector in France and Germany. It considers these tools as policy instruments.The author argues that the internal fragmentation of medical representation partially explains the introduction of these reforms. He assumes, moreover, that these reforms, which are de facto imposed on the profession, contribute to that fragmentation. They are therefore interdependent processes that mutually reinforce one another over time, accentuated by the conflictual nature of the relationship between doctors and the government. Financial compensation for doctors, which has played a significant role in negotiations, appears to be primarily a short-term benefit in exchange for concessions that materialize mostly over the long term.