CANCER POLICY AND THE HEALTH SYSTEM IN FRANCE - BIG MEDICINE CHALLENGES THE CONCEPTION AND ORGANIZATION OF MEDICAL-PRACTICE

Summary: This paper analyses the effects of French cancer policy, shaped during the inter-war period, on the genesis of a coherent, reformist conception of a health system aimed at adapting the latter to the evolution of the conditions of medical practice. It endeavours to show how the interpenetration of strategies adopted by different actors diverted the project of setting up a network of Anti-cancer Centres (ACCs) from its iniitial objective, and resulted both in an 'uncontrolled' development of care institutions and in a disparity in their equipment potentialities. Furthermore, in the course of this process, whereby the first steps of 'big medicine' were taken, two basic principles were challenged, which for more than a century had informed the functioning, the organization and the spheres of intervention of medicine. These were the absence of competition between the state hospital and the private sector on the one hand, and on the other the pertinency of the opposition of 'curable versus incurable' with a refusal to admit 'incurables' into care institutions. © 1991 The Society for the Social History of Medicine.