The French healthcare system combines freedom of medical practice with nationwide social security. It
is compulsory for every legal resident. A range of public and private institutions provide care, and
patients have free access to physicians. The health coverage system is characterized by solidarity and
universal responsibility. Although the French system is highly regulated, funding of health-related
expenses is a chronic social problem. Since the 1996 healthcare reform, the national objective for
reimbursed healthcare expenditures is voted by the parliament, and the annual increase of hospital
funding is controlled at the regional level. An agency for hospitals has been established in every region,
and it quantifies needs indexes for future equipment and beds. However, establishing appropriate reference
ratios based on objective assessment is difficult. The idea of basing policy and practice decisions on
objective assessment grew for years, until the National Agency for the Development of Medical
Evaluation was established in 1989. The 1996 healthcare reform expanded this
agency to encompass hospital accreditation and renamed it the National Agency for Accreditation and
Evaluation in Health. In March 1999, the National Agency for Health Products
was established. It controls the safety of
medical products and evaluates products' medical benefits before reimbursement decisions. Health
technology assessment is now related to virtually every health policy process in France, and its role
increases continually.