Establishing in the 1970s, the concept of a public hospital service tends to create complementarity not only between public health establishments but also between the public hospital sector and private establishments. It meets the dual economic and social requirements of a health service with controlled costs and the quality of care provided. Recent hospital structural reforms are exacerbating these developments: the public service will increasingly need to bring its resources together, structure them and prioritise them within coherent health centres and networks at national level, so as to enable the best possible service to the local population.