The bureaucratic genesis of a sectorial commonplace: Diplomatic competition and institutional support in the production of the first OECD report on health expenditure (1985)

This article describes the genesis of a controversial bureaucratic innovation through the analysis of the negotiation of the mandate of the OECD task force that published the first report on health expenditure in 1985. The report’s author—here described as a “entrepreneur-frontière”—succeeds, thanks to contacts made in national bureaucracies, in academic fields, and various other international organizations, in drawing the attention of many countries to the establishment of a database of member-states’ health expenditure. He thus compensates for the disdain of his hierarchy toward his work. In the context of a struggle between the social and economic departments for fixing the rationale behind the “crisis of the welfare state” in the early 1980s, the work on health expenditure is finally imposed, by the most powerful member-states allied with the economic division, as a consensual way to limit the social affairs task force’s prerogatives. The article then sheds light on the institutional and statistical genesis of a sectorial slogan whereby health policies’ first aim is to limit the expenditure of this sector of public action.