Admission into healthcare education in France: Half-baked reform that further complicates the system.

France has undertaken the most ambitious reform of healthcare education in more than 10 years. It has resulted in a hybrid system with multiple pathways, granting admission into the healthcare professions after competitive exams. The reform continues the trend to increase the quotas limiting the number of second year healthcare students, and also creates new local access options to healthcare education. However, the heterogeneity in implementation has led, in conjunction with the difficulties caused by the Covid-19 pandemic, to great dismay among students and parents. This article seeks to outline the historical underpinnings of the reform program(s) and argues that the core question - selecting students from the very high number of candidates in a fair and effective manner - remains largely unresolved.

Programmatic actors and the transformation of European health care States.

In France, Germany, Spain, and the United Kingdom, the decades from the late 1980s to the present have witnessed significant change in health policy. Although this has included the spread of internal competition and growing autonomy for certain nonstate and parastate actors, it does not follow that the mechanism at work is a "neoliberal convergence." Rather, the translation into diverse national settings of quasi-market mechanisms is accompanied by a reassertion of regulatory authority and strengthening of statist, as opposed to corporatist, management of national insurance systems. Thus the use of quasi-market tools brings state-strengthening reform. The proximate and necessary cause of this dual transformation is found in the work of small, closely integrated groups of policy professionals, whom we label "programmatic actors." While their identity differs across cases, these actors are strikingly similar in functional role and motivation. Motivated by a desire to wield authority through the promotion of programmatic ideas, rather than by material or careerist interests, these elite groups act both as importers and translators of ideas and as architects of policy. The resulting elite-driven model of policy change integrates ideational and institutionalist elements to explain programmatically coherent change despite institutional resistance and partisan instability.