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  • CASTEL Patrick (12)
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The popularity of labels as tools of government is growing in many policy areas. This working paper focuses on the creation and the implementation of three different public labels in the public health field. Granted by the States or other public authorities, those labels reward distinctively organizations for their contribution to a public cause. Governance by labels relies on the mechanisms of market competition and of social distinction at play within a field, to orient actors towards opinions that governments consider to be in the public interest. This working paper nevertheless shows the difficulties to implement effectively that kind of soft policy tools: for them to affect firms and consumers' behaviours, they have to integrate many conflicting objectives and interests at the same time, which is rarely the case. We actually show, in our three case studies, that governing the market through labels implies governing the labels themselves, by carefully selecting their grantee, promoting them to both consumers and companies, and struggling against other challenger labels or market intermediaries. It is not an uncommon paradox that these labels that are entrusted with such a high power of "changing the world", have been finally stripped of any power.

The popularity of labels as tools of government is growing in many policy areas. This chapter focuses on the creation and implementation of one specific kind of label, which we have defined as a “rewarding label”. These labels are granted by governments or public authorities and reward organizations for their contribution to public welfare. Governance by rewarding labels relies on the mechanisms of competition and social distinction at play within a given field, in order to orient actors towards options that governments consider to be in the public interest. Taking eco-labels and nutritional charters as case studies, this chapter shows the difficulties involved in governing through this tool. Rewarding labels are designed to satisfy a range of conflicting objectives and interests and their application has become a site of conflict among public authorities and private actors. Four limitations to this approach are highlighted: management of labels’ reputations, consumer enrolment, competition between companies, and competition between government labels and other market devices or actors.

Les faux médicaments se comptent par centaines de millions et font des ravages dans les populations. Comment comprendre que des ONG, des gouvernements ou des mouvements activistes s’opposent à la lutte contre ce fléau ?

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Functional foods have swept across France and Europe since the late 1980s. Margarines enriched with omega 3 or phytosterols, yoghurts enriched with bifidus or vitamin-rich food supplements... these foods with health claims have reopened the boundary erected over the course of the twentieth century between the markets for medicines, whose primary function is to treat the sick, and those for foods, whose primary function is to meet the nutritional needs of healthy people. They thus raise many issues for regulators, producers, distributors and consumers. Are they health products that can usefully contribute to the prevention of chronic diseases or marketing manipulations that are not of any health interest? Should they be regulated and marketed as drugs, as food or as a separate category? Drawing on significant contributions in economic history and sociology, this article analyzes the consequences of the classification of these products as medicines, foods or dietary supplements on their valuation and the structure of their markets. It also focuses on the boundary work in which industry and regulatory actors engage in order to “(re)classify” these products, and thereby “(re)structure” the markets in which they circulate. The first part of the article describes the process that led France to establish a boundary between the previously intertwined markets for medicines and foods over the course of the twentieth century, which has been blurred by the appearance of functional foods since the beginning of the 1980s. The second part deals with the efforts of French and European regulatory authorities and industry actors to renegociate these boundaries between the markets for medicines and foods bearing nutritional and health claims. We conclude this second part with a discussion of the consequences of this reframing for the reorganization of markets and the reevaluation of the health benefits and commercial advantages of these products.

in La Vie des Idées Publié en 2019
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L’économie comportementale, nouvelle obsession de nos décideurs, réduit tout à des « biais cognitifs ». Ce faisant, elle focalise les politiques publiques sur les conduites individuelles, et elle recherche les traits communs à ces conduites au lieu d’en explorer les différences. Contre cette raison comportementaliste, une analyse sociologique des structures et des inégalités s’impose.

L’article étudie les évolutions de la fixation du prix des médicaments par l’État en France depuis 1948. Si les objectifs de cette politique sont restés les mêmes depuis 70 ans (assurer l’accès des patients à des traitements de qualité, sans grever les comptes de l’Assurance maladie ni compromettre le développement de l’industrie), ses modalités concrètes ont de leur côté fortement évolué, passant d’une administration unilatérale des prix par l’État à une co-régulation du marché des médicaments. Cette transformation a amené les représentants de l’État et de l’Assurance maladie (le Comité économique des produits de santé) à composer avec un nombre croissant d’acteurs (industriels, experts indépendants, professionnels de santé mais aussi politiques pratiquées dans d’autres pays). Pour autant, elle n’a pas conduit à un retrait de l’État : au contraire, la portée de la régulation s’est étendue à l’ensemble des acteurs et des dispositifs déterminant les dépenses de médicaments remboursés.

L’économie comportementale (ou nudge) est à la mode. Comment expliquer son succès ? Peut-on attendre qu’elle révolutionne aussi bien la recherche en économie que les politiques publiques ? Ses premiers usages par les gouvernements tendent à tempérer l’optimisme.

Le projet de loi de financement de la Sécurité sociale pour l’année 2019 (PFLSS 2019), présenté par les ministres Agnès Buzyn et Gérald Darmanin le 25 septembre dernier, comporte deux mesures visant à favoriser le développement des médicaments génériques. L’une d’elles consisterait à rembourser, à partir de 2020, les médicaments originaux sur la base du prix du générique. Bien qu’elle soit présentée comme nouvelle, cette mesure reprend (et étend ?) un dispositif créé en 2003 et déjà appliqué à certains groupes génériques : les tarifs forfaitaires de responsabilité. (Premier paragraphe)

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