The first law about the organization of the French hospitals dates back to 1796 with the French Revolution which asserts the powerful administrative commission, chaired by the mayor of each town. In 1941, the new law created the job of director whose task was to apply the decisions of the commission. In the same time, the hospital practice was no longer free and the practitioners were chosen by medical boards of examiners. During the following 60 years, the commission lost its power at the advantage of the director whose authority increased at the expense of the medical autonomy. Therefore the economic necessity lead the government to keep a close eye on the operating budget of the hospitals but the search of the budgetary balance means new strategic developments for the future.

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