The rating on French public-hospital organization Assistance Publique – Hôpitaux de Paris (AP-HP) reflects strong state support underpinned by AP-HP's specific and ongoing direct supervision by the central government due to its social importance, its systemic weight 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. Following the gradual change to an output-oriented financing system from an expenditure-driven one, variable revenues have accounted for about 70% of the group's total revenues since 2008. Management has spurred major reforms to adapt the group's governance, organization, culture, and management processes
