"Almost certain" extraordinary financial support from the French Republic, in our opinion. "Critical" role for the French government, given unique position within France's hospital system. "Integral" link with the French government, translating into close direct and indirect state supervision and controls. Record of strong ongoing state support. Deteriorating budgetary performance from the output-based financing system, requiring continued efficiency gains to structurally restore positive operating income. Significant investments, leading to debt accumulation since 2006. Standard&Poor's Ratings Services equalizes its rating on French public hospital group, Assistance Publique - Hopitaux de Paris (AP-HP), with its long-term sovereign rating on the Republic of France (AA+/Negative/A-1+, unsolicited). This reflects our view that there is an "almost certain" likelihood that the French state
