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Public hospitals are major assets both for our health system and through their social role. But they have to face major challenges, i.e. a demographic challenge, changes in missions and, more particularly, the extreme specialization of certain techniques, changes in funding rules with the introduction of activity-based pricing in a very restricted budgetary context. Hospitals will either submit to these pressures and we will see a weakening of their public service role, or they will implement changes by developing actual group strategies that would enable pooling of resources from different public hospitals, or even from public and private hospitals where sustaining a high-quality treatment offer requires it. A number of measures included in the draft law on 'Hospitals, patients, health and the regions'? (H?pital, patients, sant?, territoires) will facilitate these changes. Hospitals must also improve their internal efficiency. While considerable effort needs to be made in this area, inertia and administrative constraints must not be allowed to crush their good will.