POLTON, Dominique <br/><br/>
La régulation contractuelle :  l'exemple de la biologie de ville 

 - Paris :  IIAP,  oct./déc. 1995 
<br/><br/> Contractual regulation of health care outside the hospital sector was introduced in 1991 following on overly brutal revision of the remuneration scale. This system of regulation created a three-way relatioship between the State, the health insurance and professionals in the making of annual agreement forecasting future health service expenditure. The bsaic idea behind contractual regulation is co-responsaibility. The financial framwork sets out the predicted increase in treatments with an adjustment mechanism operating a rigid system of financial compensation. This is accompanied by recommendations and the creation of emans for gathering information concerning the sector. All objectives which were forecast have been reached, but management of the system is complex. Specific negotiation with each profession brings with it a risk of inflexibility in parts of the market. The means of putting the national objetive into effect at regional level still has to be worked out. Beyond this it appears that contractualisation has its limits due to the over-protective effect of the contract which prevents spontaneous increases in spending which might be a lot less favourable for professionals. In fact what this method of contractualisation lacks is the state's vision of the aim sought t be achieved