title: [Health system reforms, economic constraints and ethical and legal values].
abstract: Health system and hospital reforms have led to important and on-going legislative, structural and organizational changes. Is there any logic at work within the health system and hospitals that could call into question the principle of solidarity, the secular values of ethics that govern the texts of law and ethics? In order to respond, we compared our experiences to a review of the professional and scientific literature from 1992 to 2010. Over the course of the past eighteen years, health system organization was subjected to variations and significant tensions. These variations are witnesses to a paradigm shift: although a step towards the regionalization of the health system integrating the choice of public health priorities, consultation and participatory democracy has been implemented, nevertheless the system was then re-oriented towards the trend of returning to centralization on the basis of uniting economics, technical modernization and contracting. This change of doctrine may undermine the social mission of hospitals and the principle of solidarity. Progress, the aging population and financial constraints would force policy-makers to steer the health system towards more centralized control. Hospitals, health professionals and users may feel torn within a system that tends to simplify and minimize what is becoming increasingly complex and global. Benchmarks on values, ethics and law for the hospitals, healthcare professionals and users are questioned. These are important elements to consider when the law on the reform of hospitals, patients, health care and territories and regional health agencies is implemented.
authors.affiliation: Chirurgien orthopédiste et traumatologue, hôpital Ambroise Paré, 1, rue d'Eylau, 13291 Marseille, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Caillol
authors.forename: Pierre
authors.initials: P
authors.lastname: Le Coz
authors.forename: Régis
authors.initials: R
authors.lastname: Aubry
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bréchat
mesh_terms: D003695:Delivery of Health Care / Q000191:economics* / Q000331:legislation & jurisprudence*; D004992:Ethics, Medical; D018166:Health Care Reform; D006801:Humans; D011634:Public Health