French hospitals are places designed to care for patients suffering from illnesses and traumas too complex to be treated at home or in a doctor's office.

In France, as part of a public service mission, hospitals can carry out complementary missions, notably in the fields of prevention, professional training, and research.

Status of French hospitals The French hospital system comprises both public and private healthcare establishments. The distinguishes between three types of establishment:

: These are state-run hospitals operated as public entities; Private for-profit hospitals: These are commercial enterprises where physicians typically work as self-employed professionals; Private non-profit hospitals: Managed by associations governed by the 1901 law, mutual insurance organizations, or foundations, these institutions pursue healthcare missions without a profit motive.

Types of public hospitals With the exception of (, HIA), public hospitals are constituted as public health establishments. There are several categories:

(, CHR): these establishments are highly specialized in various fields of medicine and surgery, and are equipped with extensive technical facilities. A CHR is generally also a teaching hospital (, CHU): this is a facility that has signed an agreement with a medical university to provide practical teaching for medical students in several medical disciplines. National Hospitals Centers (, CHN): there are two of these: the Quinze-Vingts National Ophthalmology Hospital and the (dedicated to prisoners). (, CH): providing a full range of medical, surgical and obstetric (, MCO) services. (, HL): these establishments have a low level of medicalization. Care is usually provided by general practitioners in private practice. This category of establishment is no longer mentioned in the public health code. (, CHS): these specialized mental health establishments were set up by the law of June 30, 1838.

HIAs are establishments attached to the Ministry of the Armed Forces, and more specifically to the Armed Forces Health Service. They are primarily intended for military personnel injured in the line of duty but are open to all.

Distribution +Type of establishmentEntitiesBedsOutpatient bedsPublic Sector987288 86631 238CHR and CHU2978 0656 272Hospital Centers (CH)504157 81510 834Specialized Hospital Centers (CHS)8728 95413 927Local Hospitals (HL)34722 23954Other public establishments201 793151Private sector1 869154 90119 480Acute or multidisciplinary care facility80180 96410 340Cancer research centers202 979571Establishment for the fight against mental illness24217 8864 805Follow-up care and rehabilitation facility66445 3873 682Long-term care facility1126 60924Other private establishments301 07658TOTAL2 856443 76750 718Source: Le Panorama des établissements de santé 2007. Direction de la recherche, des études, de l'évaluation et des statistiques. Figures updated to December 31, 2005. +Type of establishmentEntitiesBedsPlaces ambulatoiresPublic Sector983284 14035 705CHR and CHU3179 1547 720Hospital Centers (CH)511155 71313 233Specialized Hospital Centers (CHS)9028 01914 369Local Hospitals (HL)33419 610220Other public establishments171 644163Private sector1 801156 28722 824Acute or multidisciplinary care facility75080 80711 992Cancer research centers202 846678Establishment for the fight against mental illness23717 8225 145Follow-up care and rehabilitation facility67447 9594 732Long-term care facility845 18125Other private establishments361 672252TOTAL2 784440 42758 529Source: Le panorama des établissements de santé - édition 2010. Direction de la recherche, des études, de l'évaluation et des statistiques. Figures updated to December 31, 2008. +Type of establishmentEntitiesBedsPlaces ambulatoiresPublic Sector931258 15840 132CHR and CHU3274 7839 287Hospital Centers (CH), including former local hospitals789153 45615 847Specialized Hospital Centers (CHS)8826 70714 579Other public establishments223 212419Private non-profit sector69958 13712 342Cancer research centers182 889856Other private non-profit establishments68155 24811 486Private for-profit sector1 03098 54515 575Acute or multidisciplinary care facility54259 45812 133Cancer research centers202 846678Establishment for the fight against mental illness14011 7351 037Follow-up care and rehabilitation facility32425 9992 308Long-term care facility1250824Other private establishments1284573TOTAL2 660414 84068 049Source: Le panorama des établissements de santé - 2014 edition. Direction de la recherche, des études, de l'évaluation et des statistiques. Figures updated to December 31, 2012.

Activity In 2006, nearly 8.4 million people were hospitalized in public health establishments, 260,000 more than in 2004. 3.5 million people were hospitalized in private for-profit hospitals and 1.2 million in private community hospitals. In 2008, there were 11.9 million full-time hospital admissions and 13.2 million admissions to partial hospitalization or day care.

Hospital capacity

Bed capacity In 2006, the total number of hospital beds was 451,652: 293,667 in the public sector (public health establishments), 94,571 in private for-profit hospitals, and 63,414 in private community hospitals.

Over the past few decades, the number of beds in the French hospital system has fallen steadily, from 612,898 in 1982 to 428,987 in 2013, a decline of 30%. During the same period, the French population grew from 55.7 million to 66 million, an increase of 18.5%; the number of hospital beds per capita therefore fell by just over 40%, from 11 beds per 1,000 inhabitants to 6.5. In 2023, the number of beds in the French hospital system will be 369,400, all types of establishment combined; with a population of 68,373,433 for the country as a whole, the number of hospital beds per 1,000 inhabitants is therefore 5.4.

The number of beds corresponds to the total number of beds in the French hospital system, both public and private. The French population is expressed here in tens of thousands of inhabitants.

In 2017, there were just under 400,000 full-time hospital beds, 69,000 fewer than in 2003, and even 100,000 fewer than in the previous 20 years. Conversely, in the follow-up care and rehabilitation sector (SSR), the number of beds rose from 92,000 in 2003 to 106,000 in 2017.

More precisely, the 3,046 public and private healthcare establishments had 399,865 beds in 2017. In twenty years, no less than one bed in five has thus been eliminated, the decline having been partly offset by the creation of "partial hospitalization" places in 2017, i.e. hospitalization for less than a day.

Number of beds and staff The administrative opening of a bed in a hospital department requires a minimum number of staff, according to a legal framework:

Article D.6124-32 of the French Public Health Code states that, under the responsibility of a senior nurse, the paramedical team of an adult intensive care unit must include two nurses for every five patients, and one nurse's aide for every four intensive care beds. In reality, some beds may remain open without meeting these standards.

Article D.6124-34-5 specifies that in a specialized pediatric intensive care unit, the team comprises one nurse for every two patients. In the birthing sector, the number of paramedical staff may never be less than one nurse's aide or nursery assistant, present at all times (article D.6124-44 CSP). For each operation in the cardiac surgery department, two nurses, including one operating room nurse, are present in the room.

Staff Hospital payroll accounts for 70% of total expenditure. This wage bill can therefore be used as a budgetary adjustment variable. Between 2003 and 2007, 5,200 new staff were hired. However, hospital unions have repeatedly denounced staff shortages.

Public hospitals employ a wide range of staff with different statuses depending on their function:

Administrative and nursing staff are generally civil servants (agents de la fonction publique hospitalière); Medical staff are generally hospital civil servants under the authority of the C.N.G.; Civil servants, in particular hospital students and undergoing their initial training; Civil servants on secondment from other ministries, government departments, or agencies.

Financing

Hospital spending The French Social Security Financing Act (LFSS) for 2009 provided for €50.9 billion in spending on public and private hospitals, out of a total of €157.6 billion in healthcare expenditure. The budget for outpatient care in 2009 was 73.2 billion euros. This represented a 3.2% increase in the hospital budget. Ten years later, the projected 2019 budget for public hospitals was 82 billion euros, up 2 billion over 1 year thanks to the increase in activity-based pricing.

Public/private alignment In return for identical services, public hospitals receive more from social security than private clinics. But public and private tariffs had to be aligned by 2018. This public/private tariff alignment represented 7 billion in annual savings for public hospitals. Public hospitals, led by the university hospitals, justified their higher rates by specific missions (emergencies, teaching, research, etc.). However, they received lump-sum allocations (, MIGAC; and , MERRI) to carry out these missions, the amounts of which were not justified by a precise cost analysis.

In 2011, the French federation of clinics (FHP-MCO) filed a complaint against France in Brussels for distortion of competition. In September 2011, the French Cour des Comptes recommended more methodical preparation for this deadline, which was enshrined in law but had already been postponed once.

Safety and working conditions Hospital staff are often confronted with violence. The (ONVS), an organization under the supervision of the Ministry, in its 2015 report noted a "worsening sense of insecurity felt by healthcare staff." This violence ranges from insults to physical assaults.

The ONVS counts an act of violence every 30 minutes in French hospitals, a total of 14,502 reports of attacks on people and property in 2014. Nurses are the first to be affected. Physical violence, which is proportionally the most frequent, is on the rise, with 5,119 reports.

In the years 2000-2010, community tension became a new element in violence, with emergency departments and maternity wards the most affected. There has been an increase in violence observed in certain obstetrics gynecology departments in the Paris region and several large cities. According to Le Monde, "fundamentalist husbands refuse to allow their wives to be examined, treated or delivered by a man. They vigorously demand it, even if it means endangering their wives and physically attacking the practitioner on duty".

In September 2013, after several serious incidents, the management of the Marseille Hospitals (, AP-HM) was forced to take a series of "measures to guarantee staff safety".

Hospital reforms

1991 hospital reform This law, prepared over a period of three years and championed by ministers Claude Évin and Bruno Durieux, strengthened hospital planning, making the health map dependent on a regional health organization plan (, SROS), re-evaluated every five years. Establishments are required to produce projects.

2003 hospital reform Since January 1, 2003, the Hospital Plan 2007 has rapidly introduced a number of far-reaching changes to the way public hospitals operate:

The creation of "hospital activity clusters".