MANAGING A PLURALIST HEALTH SYSTEM - THE CASE OF HEALTH-CARE REFORM IN FRANCE

During the last decade increasing health care expenditure led to persi stent difficulties in the financing and management of the French healt h care system. A series of cost-containment measures in the 1980s and early 1990s concentrated on raising patient contributions and establis hing global budgets for public hospitals. These initiatives met with l imited success and did not address the issue of hospital management. I n 1991 new reforms were instigated to strengthen the public sector and achieve a better balance with the private sector. Although these refo rms altered management practice within public hospitals, they failed t o tackle the underlying problems of the longterm financing and managem ent of the French health system, ensuring continuing attempts at refor m. The French experience provides evidence of the difficulties of refo rming a pluralist health system that contains few incentives to stem r ising expenditure.