Quality of care initiatives in the French context.

The emergence of the issue of quality of health care systems of developed countries can be interpreted as the result of a growing pressure from payors and regulators on providers for increased accountability. As such, the form that this emergence takes is specific to each country's cultural, economic, and institutional context. A brief description of the French health care system and its political and functional dynamics is provided to set the stage and to explain how providers of care have responded to this pressure. The main emphasis has been put in a first period on the rationalization of medical practices using persuasive and coercive regulations to diffuse practice guidelines. As a consequence, medical data systems are developing in both the hospital and ambulatory care sectors. Quality assurance programmes are in their early years, and total quality management is still to come.