Health system reforms and the medical profession's future.

From 1960, when a national agreement was initially signed, to 1980, when a two-tiered convention was worked out, up till the 1990s, as regulations hav e been 'segmented' by speciality, self-employed medical professionals have been increasingly divided: at first between 'generalists' and 'specialists' and then into various groups of specialists. This segmentation has sparked further differentiation into professional organizations, itself a sign of a growing competition among segments. It has also broken the traditional po litical alliance between doctors and successive governments as the drive to control the costs of services has taken off. This segmentation causes prob lems: intended to serve the patient, it requires more co-ordination in heal th care. The involvement of certain specialities in evaluation procedures o r in health-care networks opens new means for experimenting and co-operatin g. (C) 2000 Editions scientifiques et medicales Elsevier SAS.