1.2 Hospital development

Hospital sector development had its own specifics. Before and during the Second Word War the majority of hospitals in France were public, autonomous and often attached to the municipality. At that times there were very few private hospitals so they did not have influence and importance. The situation dramatically changed after 1945 when the newly formed Ministry of Health was given special powers. All spheres of hospital activity since that year were under the control of the Ministry that enforced a centralized policy to reduce the autonomy of public hospitals. When the private hospital sector became developed enough, the Ministry extended its control over it, it happened in 1958.

This new centralized policy and strict control allowed the state to make hospital sector well organized and managed efficiently. The diversity of hospitals was one of the priorities for the government that applied the principle of pluralism in its policies. Any hospital, no matter public or private, had opportunities for the development and was supported by the state. This diversity allowed the citizens of France to choose the most suitable place to use health care services and generated a lot of working places for health care professionals. (Sandier, et al., 2004, pp.13-14)

1.3 Regulation policies development

Not only centralization was on the agenda of regulatory policies of the HC system in France. Cost containment was one of the most important issues and still remains one. With such a diversified system cost control became challenging. Since the 1970-es regulatory policies targeted not only the demand and supply of health care services, but also the behavior of health providers and budgets limitations. The tight financial frameworks on expenditure were created and remain one of the governmental controlling tools by the present time.

The third principle gained by the system while it was developing is the principle of liberalism. Victor G. Rodwin, Professor of Health Policy and Management, explains it in his book Universal Health Insurance in France How Sustainable:

Physicians should be free to practice on a fee-for-service basis, that patients should be free to choose their physicians (and vice versa), that physicians should be assured clinical autonomy, that professional confidentiality should be respected and that there should be direct payment between patients and doctors in private practice. (2006, p. 170)

The health care system in France has a long history of its development. On this way the main features of the system have formed. The all are connected with each other. The hospitals divided into two types: public and private, which made the system a public-private mix. As a result, the HC cost sharing appeared: all costs are spread between governmental and private organizations. However, the states role was identified clearly. The state gained the control over the system and became the main actor in the sphere. Moreover, the HC system acquired three main principles, which make it efficient: solidarity (means that the HC coverage in the country is universal), liberalism (states the freedom of choice for patients as well as the responsibility) and pluralism (stands for the diversity of the system). They serve as a basis and at the same time they limit the system, making it one of the best-organized HC systems in the world.