The current context of cost control relative to health expenditures forces hospitals to wonder about their management style. Therefore, the question of the efficiency of the health system is raised. Would the formalization by contract bring the beginnings of an answer ? This is what its growing development within numerous public health establishments leads one to suppose, thus signing an evolution towards some new « medical and administrative » governance. Through this article, I therefore suggest to you a questioning on the essence of the contractual method, its stakes, its limits and especially a projective approach on the consequences of this management method considering the « health executive » function. As the stake in this reflection is to highlight the fact that if the health executive has a place acknowledged in the internal formalization by contract, its competence will constitute an increase in value in the contractual process. Indeed, this questioning seems important to me and this, all the more as the ordinance dated May 2, 2005 including « various arrangements relative to the functioning of public health establishments and modifying the public health code », stipulates that public hospitals should resort to the method of internal formalization by contract in setting up centres of activity and this, at the latest, before December 31, 2006.