Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

A good deal of strategic choice has been given back to organizations, which have become actors of their (only partial) compliance with institutional demands that they in turn contribute to shaping. The reported case of the successful modernization of the French cancer centers and their reinstatement as the leaders in their field contributes to a better understanding of the role of leadership in institutional change because it demonstrates a positional approach to institutional leadership. Cancer centers' reformers were both central, because they were placed at the intersection of several potentially interdependent organizational fields or institutional spheres, and marginal to most but not all of them. This particular position of the change-entrepreneurs, with its relational constraints and also its resources, enabled them to initiate a successful drive for the transformation of the field of cancer care and also greatly explains the particular form it took. Our analysis underscores the interactive nature of institutional change, where the motor of change simultaneously structures and is structured by the process it is driving and where the initiators of reform have to create their proper and specific combination of old and new in order to build an innovative dynamic.

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RésuméComme dans toute activité collective, la coopération en médecine constitue un problème central, autant pour les acteurs concernés que pour le sociologue qui l'étudie. Or, les travaux classiques de sociologie de la santé et de la médecine n'aident guère à penser ce problème. Réfutant l'idée selon laquelle les relations entre acteurs seraient déterminées par l'appartenance à des configurations institutionnelles telles que le segment professionnel ou la spécialité, le cadre d'analyse que nous proposons cherche également à aller au-delà de la seule description de phénomènes présentés comme strictement contingents. Pour comprendre efficacement les phénomènes de coopération et de conflit, nous soutenons ainsi qu'il est possible et heuristique de distinguer les professionnels en fonction de leur positionnement sur la chaîne thérapeutique et de leur mode d'engagement dans la stratégie de soins. En particulier, la coopération se fonde sur l'appariement entre un professionnel dit « captant », qui considère devoir assurer le suivi du patient tout au long des étapes qui scandent la curation et d'autres professionnels qui conc¸oivent leur intervention comme ponctuelle et limitée à une étape de la trajectoire thérapeutique.Mots clés : Coopération ; Organisation ; Appariement ; Conflit ; Réseau ; Santé ; Sociologie des professions ; Sociologie des organisations ; Sociologie de la santé AbstractCooperation in medicine, as in any group activity, is a key problem both for the persons involved and for sociologists. Classical studies in the sociology of health and medicine are of little help in conceptualizing this problem. While arguing against the idea that the affiliation with an institutional configuration -such as a professional segment or a specialty -determines relations between persons, this analysis seeks to move

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