The search for efficiency and concentration on patient needs and satisfaction are at the topic of current conceptions in terms of the quality and organization of health services. There is indeed a relative consolidation of organizational approaches called Patient-Centered Care (e.g. CCM, DM, case management, population management) for the structured management of patients with chronic diseases and a real desire to implement them in the domain of health. This evolution continues in the management of health systems through New Public Management - NPM. There is a strong pressure on professionals (care professionals and managers) to ensure greater efficiency in terms of activities and greater efficiency in terms of the use of resources. Both developments point to a greater emphasis on personalizing care, differentiating benefits, and taking into account the satisfaction of beneficiaries of public services. However, without being antinomic, the two evolutions underlie divergent and even paradoxical issues and mechanisms. © S.F.S.P..