Competition or coordinated care?

Patrice Pinell (2002) has analysed the birth of a national policy to fight against cancer in France at the beginning of the 20th century and how this policy came to be articulated around a restricted number of hospitals specialised in cancer care. In those times, their characteristics were innovative, since these hospitals should manage research activities and treat patients at the same time while defending a multidisciplinary approach to cancer care. This meant that each medical speciality was to participate in the therapeutic decision process. The defence and promotion of radiotherapy as an emerging technique beside the dominant surgery methods was a major concern for the founders of these cancer centres. From their creation to the 1970s, these Cancer Centres were the main organisations in charge of cancer patients in France. In 1965, the French government entrusted them with organising consultations for patients in other hospitals in their regions. Until 1972, physicians appointed to the National Commission in charge of advising the government to define a national cancer policy were exclusively drawn from the Cancer Centres, as well. But from then on, things changed. Cancer Centres have faced increasing competition (by Teaching Hospitals and general healthcare organisations) and their legitimacy has bee