Medical audit in France: historical perspective.

Medical audit in France is dominated by a problem of semantics.The concept of medical audit is generally expressed by the words evaluation medicale, a broad definition that encompasses all the methods of quality assurance (peer review, studies of appropriateness, definition of guidelines and protocols, outcome, follow up, etc), of which medical audit is considered to be only one.The word "evaluation," however, is as vague as it is broad.The government; hospital management; the specialised institutions that have been created; and, finally, the medical profession each have their own definition depending on their respective objectives.These definitions are not necessarily congruent: they range from actual quality assurance or technology assessment for some, to cost containment for govern- ments or hospital administrations and to clinical research for many clinicians.In this article I will use the term medical evaluation to refer to the policy in France and quality assurance to refer to the technical quality of medical care.The development of quality assurance nationally has been observed to need two elements: political and institutional support on one hand and professional adherence and compliance on the other.In France there is no legal or customary obligation for physicians to engage in quality assurance activities, and quality assurance in the sense of quality control is not tradi- tional among French doctors, in common with doctors in most countries.In recent years the French govern- ment has emphasised the necessity of developing medical evaluation and has lately created a national committee and a national agency to support it.The importance of medical evaluation has been emphasised in a recent hospital tour.But the medical profession is wary of the govern- ment's intentions.As in all industrial countries, health policy in France has been dominated for the past 10 to 15 years by the constant theme of cost containment so that when doctors hear their minister tell them that they must evaluate medical care they cannot help understanding that they are being asked to save money.This does not help the profession's commitment.