Healthcare systems in all developed countries are facing changes in the demand for healthcare, caused by the conjunction of a multiplicity of demographic, medical and socio-economic factors, such as ageing populations, the evolution of diseases, increased expectations in respect of the quality of treatment linked to increases in national wealth, geographical mobility and so on. Expenditure on healthcare has grown at a furious pace and governments are now having to find ways of curbing that growth. According to the Organisation for Economic Co-operation and Development (OECD Health Data, 2012), France had the third highest level of health expenditure relative to gross domestic product (GDP) of all OECD countries in 2010, with only the Netherlands and the USA outstripping it. Almost 80 per cent of this expenditure is funded from the public purse. France’s expenditure per person on health is also higher than average (USD 3974 compared with an average of USD 3268).Faced with these challenges, the French government embarked in the1990s on a major reform of the hospital sector. In 1996, a regional administrative apparatus for the hospital system was put in place with the establishment of the Regional Hospital Services Agencies (Agences Régionales d’Hospitalisation (ARH)) and a new obligation on all hospitals to seek accreditation. In 2003, an ambitious reform plan, known as Plan Hôpital 2007, was launched.
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