Faced with the increasing complexity of management challenges in public health institutions — scarcity of resources, performance requirements, rising operational risks— the use of knowledge-based expert systems (KBES) is emerging as a promising technological response. This research aims to analyze the extent to which the integration of KBES makes it possible to articulate artificial intelligence, public management, financial performance and risk management in a hospital context. To do this, a structural equation modeling (SEM), using the SmartPLS 4.0 software, was conducted on a sample of 50 professionals from French public health institutions. The results reveal that the adoption of KBES significantly improves managerial efficiency, which acts as a key mediator to strengthen financial performance. KBES also contribute to better risk management through their prediction and detection capabilities. On the other hand, their direct effect on financial performance remains limited without adequate organizational structuring. The study also highlights the importance of an ethical and transparent algorithmic governance framework to maximize the impact of KBES. These results open up prospects for future comparative, multi-site or longitudinal research, in order to deepen the real and lasting impact of artificial intelligence in public health policies.