This article shows how the streamlining of work—by turning flows of users and patient records into controllable variables—modifies the nature and meaning of the work carried out by staff in the French health insurance system. The author looks at how streamlining work can influence the way in which each professional group represents users (as a productivity tool for managers, as a productivity blocker for executives, and as a resource for conferring meaning to the work of street-level bureaucrats) and sorts “good” users from “bad” ones. Although the poorest do not always play ball with managers and executives, under certain conditions, customer-facing staff can perceive the poorest as perfect users. This article thus highlights several professional sorting strategies and levels, analyzing how they follow on from and connect to one another. It is demonstrated that these practices ultimately lead to the redirection and even the eviction of the poorest users, who are dependent on complementary universal health coverage (CMU-C) and state medical aid (AME).
- Health insurance
- user screening
- customer-facing relationships
- new public management