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The realities of hospital restructurings are more complex than the image given in the media. Their objective is not only to terminate those activities no longer corresponding to the criteria of technical and business rationality, but also to reconcile the several demands – which can be contradictory – of accessibility, security and quality of care, in a context of also controlling budgetary trends. The question of bed facilities and their distribution must be appreciated in terms of these different objectives. The technical tools for restructuring have multiplied in recent decades, while the health authorities can now play on a wide variety of instruments: health cards, regional schemes for health organisation, a regime of authorisations for capacities and activities, resources allocation for public establishments, and adjustments in tariffing rates for private establishments. The regional hospitalisation agencies have to play on these different instruments to change the attitudes and opinions of their very varied corresponding partners inside the establishments, but also associated with these latter. One must particularly stress the issues raised by improvements in the internal functioning of establishments, and the development of relations between the different establishments, and between these latter and the private health professionals, as well as a reshaping of the territorial cover. The question of medical demographics is a determining element in hospital restructurings, in particular in those regions like “Champagne-Ardenne” which suffer from a lack of attraction. From this may result accelerated changes in the hospitals fabric, which will require more control rather than any stimulatory action.