[The restructuring of the American hospital sector in the arena of managed care].

This article summarises the evolution of management in American hospitals under managed care. More specifically, the article is centred on the measures decided upon by hospitals over the past years aiming to improve profitability which was neglected by managed care organisations. These measures involve both internal and external reforms and have largely weakened many hospitals, but have also allowed for the implementation of a number of systems that benefit the policyholder (therapeutic recommendations, a comparative study of care offered by health institutions, etc.). Furthermore, not all hospitals handle these difficulties with the same success, depending on their geographical location or their status. Some are reinforced by these strategies, while others are forced to close. These measures have often resulted in mergers between hospitals, reorganisation of services, or laying off personnel. While some of these strategies are above all strategies for withdrawal, which translate into savings that are detrimental to patients, it is equally possible to observe strategies for recovering demand (specialising care, partnerships in research and prevention, etc.). The latter, however, is less frequent than the former, which shows the serious crisis American hospitals are experiencing today.