The rating on French public hospital organization Assistance Publique – Hôpitaux de Paris (AP-HP) reflects its track record of strong state support, its specific and direct supervision by the central government due to its systemic importance in France's health care budget, and its national flagship role for medical education and research. The rating also reflects AP-HP's strong business profile as Europe's largest hospital group, representing about 50% of Paris' and 30% of Ile-de-France's hospital capacity and activity. The rating also takes into consideration AP-HP's modest financial risk profile reflecting, in particular, low debt leverage despite a relatively weak operating margin. Management has spurred major reforms to adapt the group's governance, organization, culture, and management processes so that they are able
