The pricing rules of mutual insurance companies: a basis for a commercial representation of health insurance?

Cécile Vasseur (2023)

Journal de gestion et d’économie de la santé, 4(4), p. 253-273

Résumé. L’article apporte des éléments explicatifs sur les règles de tarification des contrats individuels proposés par les mutuelles. Les mutuelles de santé sont des organismes particuliers dans le secteur de l’assurance maladie complémentaire ; ce sont des organismes non lucratifs qui revendiquent la présence de valeurs de solidarité dans leurs pratiques.
La littérature existante en économie sur la tarification en assurance santé montre que les mutuelles ont tendance à proposer davantage de contrats ayant des mécanismes de redistribution. L’objectif de l’article est de comprendre pourquoi et comment les mutuelles peuvent faire vivre une politique de redistribution dans leur contrat via leur mode de tarification. Pour ce faire, l’article s’inscrit dans la lignée des travaux en économie des conventions et considère que les règles de tarification révèlent des tensions et des arbitrages internes dans les mutuelles de santé. Une méthode mixte est utilisée, associant démarche quantitative et qualitative. Mobilisant une enquête de la DREES sur les contrats les plus souscrits auprès des organismes complémentaires, le traitement statistique consiste à construire une classification des contrats individuels à partir de leurs modes de tarification. L’analyse qualitative prend la forme d’un traitement d’entretiens semi-directifs réalisés auprès d’acteurs mutualistes.
L’article présente trois résultats principaux. D’abord, les règles de tarification les plus redistributives dans les contrats individuels sont introduites dans des segments particuliers (fonction publique et anciens salariés d’entreprises). Ensuite, dans un contexte de rapprochement des pratiques tarifaires des mutuelles avec celles des sociétés d’assurance, l’article montre une diversité des règles tarifaires dans ces organisations. Enfin, la solidarité est un principe constitutif des mutuelles avant d’être un mécanisme de redistribution. Il existe une pluralité de représentations associées à la solidarité : assistance, redistribution et participation à un collectif. L’argument de solidarité peut alors être mobilisé pour justifier à la fois des règles de tarification redistributive et une pratique d’assistance.

Abstract. The article provides explanations on the pricing rules for individual contracts offered by mutual insurance companies. Mutual health insurance companies are special organizations in the supplementary health insurance sector; they are not-for-profit organizations that claim the presence of solidarity values in their practices.
The existing literature in economics on health insurance pricing shows that mutuals tend to offer more contracts with redistribution mechanisms. The objective of the article is to understand why and how mutuals can implement a redistribution policy in their contracts via their pricing system. To do so, the article follows the work in economics of conventions and considers that pricing rules reveal tensions in mutual health insurance. A mixed methodology is used, combining quantitative and qualitative approaches. Based on a DREES survey of the most popular contracts taken out with supplementary health insurance organizations, the statistical treatment consists of constructing a classification of individual contracts based on their pricing methods. The qualitative analysis takes the form of semi-directive interviews with mutual insurance companies.
The article presents three main results. Firstly, the most redistributive pricing rules are introduced in specific segments (civil servants and former company employees). Secondly, as the pricing practices of mutual health insurers converge with those of insurance companies, the article shows the diversity of pricing rules in these organizations. Finally, solidarity is a constitutive principle of mutuals before being a redistribution mechanism. There is a plurality of representations associated with solidarity: assistance, redistribution and participation in a collective. The solidarity argument is used to justify both redistributive pricing rules and assistance practices.

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Metamorphoses of authority and ‘government by standards’: contributions from the pragmatic sociology of bigness, conventions and engagements

Laurent Thévenot & Gabriel Nardacchione (2024)

Antropolítica 56(1). Open acces

Resumen. El artículo desmonta el funcionamiento de un nuevo modelo transnacional de “gobierno por estándares”, cuya autoridad va más allá de los Estados-nación y se extiende a los campos más diversos, desde el agro-ambiente al desarrollo urbano, la educación y la política. El análisis empírico se basa, en particular, en una encuesta internacional a gran escala dedicada a la certificación mundial del aceite de palma “sostenible”. El marco teórico adoptado para analizar esta metamorfosis contemporánea de la autoridad es el de la sociología pragmática de las convenciones comunes y los involucramientos personales. El análisis distingue entre formas más o menos instituidas de convenciones comunes, que revisten de autoridad a los seres humanos, y sus dependencias medioambientales que las ponen en valor. Este enfoque sobre la autoridad se introduce y discute a través del comentario de un cuento que tiene múltiples orígenes culturales, “Las nuevas vestimentas del emperador”. En él aparece la duda radical sobre las formas convencionales (“el rey está desnudo”) que se encuentra en el centro de la crítica contemporánea. El gobierno por estándares, muestra el artículo, amplía la gramática liberal acerca de lo común, que se basa en el formato de individuos autónomos que eligen entre opciones conocidas por todos. Este gobierno pretende integrar una amplia gama de bienes políticos y morales mediante la certificación de las opciones ofrecidas para la elección. El resultado de nuestro análisis es ampliar el dominio de la crítica exponiendo las diversas opresiones que este gobierno y sus formas investidas imponen sobre los involucramientos personales y las construcciones de lo común.

Abstract. The article unravels the workings of a new transnational “government by standards”, whose authority extends beyond that of nation-states and into the most diverse fields, from agri-environment to urban development, education and politics. The empirical analysis is based in particular on a large-scale international survey devoted to the worldwide certification of “sustainable” palm oil. The theoretical framework adopted to address this contemporary metamorphosis of authority is the pragmatic sociology of shared conventions and personal commitments. The analysis distinguishes common conventional forms, more or less instituted, that clothe with authority human beings, and their environmental dependencies that enhance their value. This approach to authority is introduced and discussed through a commentary on a tale of multiple cultural origins, “The Emperor’s New Clothes”. It features the radical doubt about conventional forms (“the king is naked”) that lies at the heart of contemporary criticism Government by standards, the article shows, extends the liberal grammar of the commons, which relies on the format of autonomous individuals choosing from options known to all. This government claims to integrate a wide range of political and moral goods by certifying the options offered for choice. The result of our analysis is to expand the realm of critique by exposing the various oppressions that this government and its invested forms impose on personal commitments and the construction of the common.

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From science policy to research administration: The bureaucratization of science-industry relations in France (1959–1965)

Jean-Baptiste Devaux (2023)

Revue française de socio-économie, 31, pp. 111-130

Résumé. Cet article porte sur la genèse des politiques de soutien à l’innovation en France et l’émergence de savoirs de gouvernement de types économiques consacrés au gouvernement des activités liant la science et l’industrie. En observant les recompositions de l’État et de l’espace bureaucratique entre 1959 et 1965, nous souhaitons faire apparaître le fait que ces deux processus procèdent de la même dynamique. La construction des relations science-industrie comme un objet savant par les économistes rend en effet possibles la mise en administration des relations science industrie et le pilotage par le centre des politiques technologiques. L’extension des capacités d’action de l’État central procède de la mobilisation de savoirs économiques. Il accompagne par ailleurs le développement de l’économie de la recherche comme sous-discipline autonome au sein des sciences économiques.

Abstract. This paper focuses on the genesis of innovation policies in France and on the emergence of economic knowledge devoted to governing activities linking science and industry. By examining the reconfiguration of the state and that of the bureaucratic space between 1956 and 1965, we seek to show that these two processes proceed from the same dynamic. The construction of science-industry relations as an object by economists made it possible for science-industry relations to be administered and for technological policies to be governed from the “centre.” Economic knowledge thus created new state capacities. It also led to the development of the economics of research as an autonomous sub-discipline within the economic sciences.

Extrait: “4.2. Administrer un territoire de nomenclatures et de chiffres
Tout au long de la décennie 1960, la DGRST va entretenir la dynamique de « mise en forme économique » de la science et de la technique. Elle transforme la « science et la technologie » en un territoire rationalisable, fait de chiffres, de nomenclatures ou de « conventions » économiques [Eymard-Duvernay, 2013].” (p. 126)

Extract: “4.2. Administering a territory of nomenclatures and figures
Throughout the 1960s, the DGRST maintained the momentum of the “economic shaping” of science and technology. It transformed “science and technology” into a rationalizable territory, made up of figures, nomenclatures or economic “conventions” [Eymard-Duvernay, 2013].” (p. 126)

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Diana Holmqvist (2024)

European Educational Research Journal, Online first, open access

Abstract. Management tools do more than manage and organise – they classify and contribute to the construction of education-as-concept. This article shows how tendering-based procurement, used by Swedish municipalities to outsource adult education to non-public providers, works to commensurate ‘education’ into measurable tender evaluation criteria. Drawing on the sociology of conventions approach and 47 procurement examples, I show that tendering evaluation criteria define what constitutes ‘desirable’ education through various degrees of commensuration. Further, I show how mechanisms intended to evaluate and compare bids also construct the value of education different – for example, promoting cost-efficiency as valuable; constructing education as an on-demand service; or by assuming a supply-and-demand approach and viewing value as fluid. Based on the exemplified commensurations and valuations, I discuss the consequences of education privatization via tendering-based procurement. Since competition is inherently built into the tool, it becomes valuable. Further, procurement recasts education stakeholders into market roles and reshapes their relationships. In short, the article underscores the importance of understanding how education privatization is organized and what role management tools play in shaping education, calling for critical education research to delve into their dynamics and impact.

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Mutual insurers’ use of contractual agreements. The health planning integrated into a market logic

Cécile Vasseur (2023)

Économie appliquée, 1(5), pp. 143-166

Résumé. Les réseaux de soins, créés par des organismes complémentaires, sont des conventions réalisées entre les assureurs privés et des établissements afin d’encadrer les prix de certains dispositifs médicaux (lunettes, prothèses dentaires et auditives) et les pratiques des professionnels des établissements conventionnés. L’article analyse les usages du conventionnement par les mutuelles de santé pour comprendre pourquoi elles conventionnent avec des réseaux de soins alors qu’elles bénéficient d’établissements mutualistes, appelés services de soins et d’accompagnement mutualistes (SSAM), dans lesquels les prix et les pratiques sont déjà encadrés par elles. L’article repose sur une enquête qualitative, prenant la forme d’entretiens semi-directifs, réalisés auprès d’acteurs issus de mutuelles ayant une activité d’assurance et de mutuelles gérant des SSAM. En nous appuyant sur le cadre théorique de l’économie des conventions, nous considérons que les conventionnements entre les mutuelles et les établissements reposent sur une coordination industrielle : les mutuelles les utilisent dans un objectif de maîtrise et de prévision des dépenses de santé. Si les conventionnements reposent sur une convention industrielle, leur usage dans le marché de l’assurance maladie complémentaire est soutenu par un compromis marchand-industriel. Les mutuelles pratiquent des conventionnements afin d’étendre leur pouvoir de marché.

Abstract. Health care networks, created by complementary health insurance organizations, are agreements between private insurers and health care establishments to control the prices of certain medical devices (eyeglasses, dentures and hearing aids) and the practices of the professionals working in the establishments under agreement. This article analyzes the use of agreements by mutual health insurers to understand why they enter into agreements with healthcare networks when they benefit from mutualist establishments, known as “Services de soins et d’accompagnement mutualistes” (SSAM), in which prices and practices are already regulated by them. The article is based on a qualitative survey, in the form of semi-structured interviews, with stakeholders from mutual insurance companies and mutual insurance companies managing SSAMs. Based on the theoretical framework of the economics of convention, we consider that agreements between mutual insurers and establishments are based on industrial coordination: mutual insurers use them to control and forecast healthcare expenditure. If these agreements are based on an industrial convention, their use in the supplementary health insurance market is underpinned by a market-industrial compromise. Mutual insurers use agreements to extend their market power.

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Giving body back to the patient. A conventionalist analysis of care

Philippe Batifoulier & Ariane Ghirardello (2023)

Économie appliquée, 1(5), pp. 21-43

Résumé. Cet article a pour objet de faire une synthèse des apports d’un des principaux courants en économie politique de la santé : l’économie des conventions (EC) en prenant le patient comme fil directeur. L’objectif de cette approche est de reconnaître une pluralité de valeurs en rejetant l’approche monolithique de l’économie mainstream. Elle vise à prendre au sérieux la primordialité de la santé, essentielle au bien-être individuel et collectif. Cette approche nous permettra de proposer un panorama des capacités de jugement des patients concernant la qualité des soins. Parallèlement, en matière de politique de santé, l’appui sur l’approche conventionnaliste donne une explication de la montée d’une logique que nous qualifions d’industrielle-marchande. Le recours à l’EC permet de comprendre pourquoi, malgré la force de la critique, la logique capitaliste peut pleinement se développer dans le champ de la santé.

Abstract. The aim of this article is to summarize the contributions of one of the main currents in political health economics: economics of convention (EC), taking the patient as the guiding principle. The aim of this approach is to recognize a plurality of values, rejecting the monolithic approach of mainstream economics. It aims to take seriously the primordiality of health, essential to individual and collective well-being. This approach will enable us to pro-pose a panorama of patients’ ability to judge the quality of care. At the same time, in terms of health policy, the conventionalist approach provides an explanation for the rise of what we describe as an industrial-market logic. The use of CE allows us to understand why, despite the strength of criticism, capitalist logic can fully develop in the field of healthcare.

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Svetlana Serdyukov & François Grima (2024)

European Management Journal, Online first

Abstract. This study examines how a board of directors and management team establish an agreement under an agricultural cooperative governance structure. We carried out a case study of an agricultural cooperative based in France, the board members and management team of which were interviewed and observed for over four years regarding their ability to create and maintain an agreement in the governance of the cooperative. Building on the theory of conventions, our findings indicate that board members’ and managers’ hybridity constitutes the basis for establishing a compromise and developing a trusting relationship between board members and managers. Furthermore, we highlighted the chairperson’s crucial role in building, negotiating, and permanently repairing cohesion between these two bodies. Our study contributes to a more holistic understanding of the relationship between the board and management by explaining how previous experiences in different “worlds” (e.g., farming, cooperative, commercial) create hybrid individuals and how this facilitates agreement between actors with different dominant logics.

Extract: “Our results provide reassuring answers about this new way of managing a cooperative. Similarly to Rolandsson’s (2017) study of the police, our work shows how it is possible to co-produce an agricultural cooperative’s management. This compromise, to use Boltanski and Thévenot’s (2006) terminology, is fragile (Demers & Gond, 2020;Straub, 2018) and based on several factors. The first involves recognizing the plurality of justifying logics between both cooperative directors and managers. This reflects individuals’ ability to mobilize different magnitudes associated with specific worlds (Cloutier & Langley, 2013). As Gàlvez et al. (2020) pointed out, this research shows that individuals are not subject to social logics but are capable of mobilizing different values associated with different worlds. The actors’ capacity for agency is strong. If institutional logics are constraints limiting the actors’ room for maneuver, they can also be considered as resources to be mobilized.
The second factor involves an emphasis on “composite objects” (Boltanski & Th´evenot, 2006). This research established that composite objects could take the form of people with particular characteristics. In this respect, this research resonates with that of B´erub´e and Demers (2019) and Morgana (2019), who stress the importance of analyzing people to understand how agreement is constructed. This work specifies the contours of individual characteristics that influence creating consensus. Analyzing past professional trajectories and motivations to work in a cooperative showed that one dominant logic of justification coexists with another. This mix comprises a much more complex whole than the literature suggests. The cooperative directors referred mainly to community logic, but they also mobilized the commercial register. While the salaried managers were part of an industrial and commercial approach, they were also sensitive to communal justification. This hybridity between the two populations is therefore based on a common base they shared before meeting. This result is consistent with Oldenhof et al.’s (2014) in that it highlights managers’ importance in building an agreement, because their backgrounds allow them access to differing values from several worlds. By highlighting personal characteristics’ role in the emergence of “composite objects,” this research enriches the previous literature, which focused on constituting agreement or managing disagreement by enhancing our understanding of the strategies that actors developed (B´erub´e & Demers, 2019; Brandl et al., 2014; Dionne et al., 2018; Munzer, 2019). Our findings contribute to the literature on governance as well, by explaining how directors’ hybridity diminishes relational risks (Zhang, 2013) resulting from a lack of satisfactory cooperation between the board and management team.” (p. 9-10)

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Spatial inequality – seeing like a federal state. Development and consequences of a quantifying territorial policy in Germany

Walter Bartl (2024)

Wiesbaden: Springer VS

Über das Buch. Räumliche Ungleichheiten innerhalb von Staaten haben jüngst an Bedeutung gewonnen, wie die geografische Verteilung von Wahlergebnissen in vielen Ländern zeigt. Das Buch analysiert die Rolle von Indikatoren sowohl für die Messung von räumlichen Disparitäten als auch für die Steuerung kompensatorischer Interventionen des Staates. Indikatoren vermessen Raum typischerweise in einem territorialen Schema, was nicht unbedingt den durch Praktiken konstituierten Räumen entspricht. Der Band untersucht die Territorialpolitik staatlicher Akteure in den Politikfeldern Kommunalfinanzen, Bildungsinfrastruktur, Regionalförderung und Asylverwaltung primär am Beispiel Deutschlands. Er zeigt, dass Indikatoren nur in einigen dieser Politikfelder eine Schlüsselstellung erreicht haben.

About the book. Spatial inequalities within states have recently gained in importance, as the geographical distribution of election results in many countries shows. This book analyzes the role of indicators both for measuring spatial disparities and for guiding compensatory interventions by the state. Indicators typically measure space in a territorial scheme, which does not necessarily correspond to the spaces constituted by practices. This volume examines the territorial policies of state actors in the policy fields of municipal finances, educational infrastructure, regional funding and asylum administration, primarily using Germany as an example. It shows that indicators have only achieved a key position in some of these policy fields.

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