The French health care system combines freedom of medical practice with nation-wide social security. The system is centrally regulated with specific attention to technology. Prices and budgets are also regulated. Despite these controls, concerns about quality of care began to appear in France in the 1970s. At the same time, increasing costs became an issue. Health care technology assessment has been under discussion as part of the solution to these problems since the early 1980s, but little was done until 1989, when a national agency was established to develop and coordinate health care technology assessment in France. In 1991, a new law on hospitalization strengthened the role of the government in health care and required extensive evaluation activities. The law has made legal requirements for the health care system and the government at all levels, as well as establishing specific institutions and public grants to support evaluation and related activities. While further evolution of the health care system is inevitable, it seems clear that technology assessment is becoming one of the key tools for addressing problems of quality of care and rising costs.