Accounting and Health Care: Costs, Tariffs and Public Hospitals in France

Combining Science and Technology Studies (STS) and policy instrument analysis to understand the production of tools of governement

Pierre-André Juven is a doctor of MINES ParisTech since the 7th of October 2014

Combining the sociology of policy instruments and science and technology studies, the thesis analyses these devices in the multiple sites where they spread: the Ministry of Health, a public agency, research centres in management studies, hospital federations, patients organizations and public hospitals.

This research on the modes of quantification of hospital activity has involved a strong field work to understand how costs and tariffs have been calculated. Pierre-André Juven has therefore studied how the public administration and two research centres in management studies have invented the calculation of costs in hospitals. By focusing on quantification as an ongoing process, he has shown that the ways in which things are calculated imply political choices.



Quantification as a qualifying process: when the tariff implies the definition of the measured entity

The dissertation exposes also how these devices have turned public hospitals into accounting and financial entities. Pierre-André Juven focuses on the pricing payment system (called T2A) and analyses it as a qualculation instrument (referring to Michel Callon’s and Franck Cohoy’s works) that qualifies and quantifies patients, hospital stays, diseases, and the public hospital itself. The dissertation shows how this qualculation process produces metrological controversies in which actors put into question the way in which things are qualculated. Pierre-André Juven shows how some patients are rendered profitable and others are made too expensive for hospitals because of the way hospital stays are calculated.


Pierre-André Juven graduated from Sciences-Po Rennes. He obtained his diploma and his Masters degree in 2010. As a student at Sciences-Po Rennes, he studied the transformation of public structures and wrote two theses on the evolution of the French national railway company. By examining how tools change organizations and produce forms of re-bureaucratization, he connected the study of managerial devices and that of political choices.

He did his PhD under the direction of Vololona Rabeharisoa at the Centre for the Sociology of Innovation, MINES ParisTech - CSI. His researches focused on the valuation process of hospital activities but also more generally on the capacity of measures to make things real and to define the entities that they calculate. He has also been a teacher assistant at MINES ParisTech (sociology of controversies), at the University Paris Dauphine and at the University of Clermont-Ferrand (political science). Considering the discussion about costs and the tariffs as a democratic matter, he has also engaged a public debate about economic modes of regulation of public hospital and published several articles in the media (Mediapart, Le Monde).