Health responsibilities shift to regions

Four scenarios outline a new distribution of responsibilities in health matters, with regions strengthening their investments and gradually expanding their scope of intervention. The role of the ARS (Regional Health Agencies) and regions in health decisions is at the heart of current debates.

Regional funding for health grows

In 2024, the regions allocated 8.24 euros per inhabitant to health, compared to 2.40 euros in 2015. In 2025, their spending in this area exceeded 573 million euros, to which were added 1.6 billion euros devoted to health and social training.

Expanding regional health roles

According to the study, 83% of the regions now have a roadmap or a dedicated health strategy. Historically competent in health and social training since the 2004 law, the regions have gradually intervened in a broader field: health territory planning, support for the installation of professionals, coordinated practice, prevention, environmental health, digital and innovation.

New law enables regional health action

The 2022 "3DS" law regarding differentiation, decentralization, deconcentration and various measures for simplifying local public action also opened the possibility of a more direct intervention in access to primary care. The question is no longer whether the regions have a role to play in health. The question is: how to recognize, clarify, secure and amplify this role?

Health as a territorial priority

According to its authors, health has become a transversal issue for territorial planning, attractiveness and territorial cohesion. For Françoise Tenenbaum, vice-president of the Bourgogne-Franche-Comté Region and representative of the Health, Health Care, and Social Training Commission of the Regions of France, the regional level is essential to adapt health policies to local realities and reduce inequalities in access to care.

Health and living conditions linked

This approach requires better integration of health and territorial planning, taking into account the living conditions of the population. You cannot guarantee access to care if you do not first work on the inputs and the determinants of health, such as environment, transport, income, housing, lifestyle, prevention, etc. Access to care does not depend solely on the number of doctors or the presence of facilities, but also on the organization of the territory and the factors that influence health.

Shared steering between regions and ARS

Françoise Tenenbaum favors shared steering between the regions and the ARS, a scenario likely to gain consensus among regional presidents. The regions have never wanted to eliminate the ARS. That is not the issue, she reminds, emphasizing that the agencies have important technical expertise.

Strengthening regional influence

She suggests rather strengthening the role of the regions in decisions relating to access to care, medical attractiveness and territorialized prevention. We can imagine a reinforced duo, ARS-region, she explains. The regions could also participate more in defining the priorities of the regional health project (PRS), which the ARS and the ministry currently control.

Localizing health policy

The objective is to give more territoriality, more impact and more feedback from the territory, so that health policies better meet local needs.