This chapter explores the paradoxical problem of competitiveness in public hospitals. Traditionally, it is admitted that health and competitiveness are two antithetical words. Indeed, in the French theory of Public Service, health cannot depend on economics; however, public health has real costs which are difficult to sustain in times of crisis. This is the why public hospitals are increasingly being invited to be competitive. The chapter analyses the situations in which a public hospital is placed in a position where it has to compete and to be competitive. Moreover, it critically surveys how the law is pushing the French public hospital model to change, in order to answer its duty of competitiveness. Finally, it suggests that a balance is needed between the requirements of public service and solidarity, on the one hand, and those of competitiveness and economics, on the other.