Abstract
The report on the future of the health care system in France focuses on the challenges facing the system and the changes needed to implement new policies. These challenges are similar to those faced by other O E C D countries. However, the implicit operating model of the health care system that structures the «Horizon 2020» report does not provide insight into the underlying dynamics of this system. The four main logics driving any health care system and providing the framework for actors' decisions and practices are professional, technocratic, market and democratic. The predominant role given to the technocratic approach does not reflect the complexity of phenomena nor does it recognize the importance of the professional logic. However, it is renewed tension between the various forces influencing the regulation of the French system that will open new avenues for implementing changes. The motors of change can be summarized as follows: the production of a mobilizing vision of tomorrow's health care system; the emergence of a new leadership which will be able to rely on health care professionals; the definition of new forms of incentives that attribute an important role to values and knowledge; and, finally, the development of strategies for experimenting with new types of organization and practice.
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