The French health system is undergoing a rather big change in its organization.  Throughout the spring and summer of 2009 the Assemblée Nationale debated a complex law, "Hospitals, Patients, Health and Territory" (HPST) that attempts to reorganize the way the health care delivery system and public health are structured.  The new law calls for the creation of a series of Agences Regionale de Sante (ARS) which will take on greater powers than the predecessor hospital regions (ARH). The regional agencies will, in the words of the Minister for Health, Roselyne Bachelot: "organize the delivery of healthcare across their regions from a perspective of improving access to care and the state of health of our fellow citizens."

The law was finalized in October of 2009 after considerable debate and many amendments.  The first concrete step in realizing the ARS structure has been the appointment of 26 "prefigurateur" or "pending" directors of the ARS.  They are charged with making this complex law come to life.  They will be challenged by the structure of the broader system of government of France which gives some overlapping powers to the "prefets" or prefects, who represent the national government at the regional and subregional level.  In France, local government leaders have a role in the  governance of hospitals and public health systems.  There will be an inevitable clash between ARS directors and the prefectural structure.

I will comment more about the implementation of the HPST law over the coming weeks as it anticipates aligning some aspects of the health care delivery system with American institutions, especially in primary care.