Sensemaking et évolution des pratiques éthiques : le cas d'une clinique mutualiste en contexte de généralisation du dépassement d'honoraires

The French health sector is marked by a constant increase of most doctors' charges exceeding the statutory fees, and leads to a segmentation between a lucrative medicine, and a free disreputable medicine for the poorest. The failure of non profitable hospitals could make difficult for them to recruit doctors and surgeons. This issue is central for the mutualist clinics, because their ethics are based on the respect of the statutory fee. That is why our problem will be: How can a loss of meaning in the statutory fee practice could lead to a change of mutualist ethics? The aim of this communication is to show the social construct aspect of ethics. Questioning the meaning of a practice leads to understand how a practice could change depending on the context, and how it could be described as ethical or not. The first part of this communication will define the concept of ethics throughout sensemaking (Weick, 1976). The second part will expose the result of a case study, explaining how a mutualist clinic is dealing with the doctors? charges exceeding the statutory fee. It shows first that the staff?s representatives about this practice is changing towards a loss of meaning, and secondly, that this context leads to new strategies for the doctors and surgeons (Swidler, 1986), which consist in making charges only slightly exceeding the statutory fee. With the approving silence of the head.