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Key Facts: Directeur d'Hôpital (EHESP / CNG) Exam

Catégorie A+

Senior civil service corps status in the French Hospital Civil Service (FPH)

Décret n° 2005-921 modifié & Code général de la fonction publique

0 €

Examination registration fee on the official CNG portal

Centre National de Gestion (CNG)

24 Months

Paid executive residency training program at EHESP in Rennes

École des Hautes Études en Santé Publique

5 / 20

Eliminatory mark threshold: any test score below 5/20 eliminates the candidate

Arrêté du 19 juin 2024

Places opened across the four 2026 concours routes

Arrêté du 26 janvier 2026

The Concours de Directeur d'Hôpital recruits senior executives for French public hospitals. The current external format uses four written papers totaling 18 hours, followed by collective, interview and English admission tests. The 2026 opening provided 97 places across four routes. This 100-question English MCQ bank is a study adaptation of the governing knowledge, not an official-format simulation.

Sample Directeur d'Hôpital (EHESP / CNG) Practice Questions

Try these sample questions to review concepts for the Directeur d'Hôpital (EHESP / CNG) exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Under Article L. 6141-1 of the Code de la santé publique (CSP), what is the definitive legal status of an Établissement Public de Santé (EPS) in France?

A.A commercial public enterprise (EPIC) endowed with full commercial law autonomy

B.A legal person governed by public law (personne morale de droit public) endowed with administrative and financial autonomy

C.A decentralized administrative department directly subordinated to the territorial prefecture

D.A public-private hybrid foundation governed by private civil law under public interest delegation

Explanation: According to Article L. 6141-1 of the Code de la santé publique, French public health establishments (Établissements Publics de Santé - EPS) are legal persons governed by public law (personnes morales de droit public) possessing administrative and financial autonomy. While they operate under the administrative supervision (tutelle) of the State exercised primarily through the Agence Régionale de Santé (ARS), they possess distinct legal personality, own property, have an independent budget (EPRD), and are legally represented by their Director.

2What executive role does the Director General of the Agence Régionale de Santé (ARS) exercise regarding the chief executive (Directeur) of a public healthcare establishment (Centre Hospitalier)?

A.The ARS Director General directly appoints the hospital director without CNG consultation

B.The ARS Director General exercises day-to-day hierarchical disciplinary authority over hospital executives

C.The ARS Director General participates in the appointment procedure managed by the CNG and sets the director's annual strategic performance objectives

D.The ARS Director General chairs the hospital Directoire ex officio

Explanation: While hospital directors belong to a national Category A+ civil service corps managed by the Centre National de Gestion (CNG) under the authority of the Minister of Health, the ARS Director General plays a key supervisory role. The ARS DG is consulted on candidate selection, conducts annual performance reviews (entretien d'évaluation), and defines institutional strategic targets within the framework of the Contrat Pluriannuel d'Objectifs et de Moyens (CPOM).

3Under the Loi Kouchner of 4 March 2002 (Article L. 1111-7 CSP), what is the statutory deadline for an EPS to provide a patient direct access to their medical records for healthcare delivered within the past five years?

A.Within 8 days following the request, subject to a mandatory 48-hour reflection period

B.Immediately upon verbal request at the hospital reception desk

C.Within 30 calendar days following transmission of an administrative summons

D.Within 2 months after approval by the departmental medical council (Conseil de l'Ordre)

Explanation: Under Article L. 1111-7 of the Code de la santé publique, health records dated less than five years must be communicated to the patient (or their legal representative) within a maximum of 8 days following formal receipt of the request. However, access cannot be granted before a mandatory 48-hour reflection period has elapsed. For medical records older than five years, the communication deadline is extended to two months.

4Under Article R. 1112-7 of the Code de la santé publique, what is the standard minimum retention period for hospital medical records following the patient's last stay or consultation?

A.5 years

B.10 years

C.15 years

D.20 years

Explanation: Article R. 1112-7 of the Code de la santé publique provides that hospital medical records must be preserved for a minimum of 20 years from the date of the patient's most recent stay or consultation. Specific exceptions apply: records of minors must be retained until their 28th birthday, and records of deceased patients must be retained for at least 10 years following the date of death (unless the 20-year period expires earlier, in which case the 10-year post-death floor applies).

5In accordance with Article L. 1111-6 of the Code de la santé publique, what is the legal role and scope of authority of the *personne de confiance* designated by an adult patient?

A.To automatically replace the patient in signing financial payment commitments and medical invoices

B.To accompany the patient through care steps and express the patient's wishes if the patient becomes unable to express their will

C.To legally authorize organ harvesting regardless of prior registered objections by the patient

D.To hold civil power of attorney (tutelle légale) over all personal assets of the patient during hospitalization

Explanation: Under Article L. 1111-6 CSP, any adult patient may designate in writing a trusted person (*personne de confiance*—relative, close friend, or treating physician). This person accompanies the patient in medical consultations, assists in understanding medical information, and, critically, must be consulted by healthcare practitioners if the patient becomes incapable of expressing their own wishes. The testimony of the *personne de confiance* prevails over that of any other family member or relative, unless advance directives exist.

6How do *directives anticipées* (advance directives) established under the Loi Claeys-Leonetti of 2 February 2016 apply to medical decision-making in a French hospital?

A.They are purely consultative notes that treating physicians may disregard without formal justification

B.They expire automatically after three years and must be notarized to remain valid

C.They are legally binding upon the physician, except in life-threatening emergencies pending assessment or if deemed manifestly inappropriate following a collegial procedure

D.They apply only to psychiatric treatment decisions and require approval by the Juge des libertés et de la détention

Explanation: Under Article L. 1111-11 CSP, amended by the Loi Claeys-Leonetti of 2 February 2016, advance directives (*directives anticipées*) are legally binding (*s'imposent au médecin*) for all decisions concerning investigation, intervention, or treatment limitations. A physician may only refuse to apply them in two situations: in a vital emergency during the time needed to perform a full medical evaluation, or if the directives appear manifestly inappropriate or non-conforming to the actual clinical situation, which requires an obligatory multidisciplinary collegial procedure (*procédure collégiale*).

7In psychiatric care without consent, what distinguishes standard admission at the request of a third party (*admission en soins psychiatriques à la demande d'un tiers* - SDT) from the emergency SDT procedure under Article L. 3212-1 CSP?

A.Standard SDT requires two medical certificates (one external), whereas the emergency procedure requires a single medical certificate certifying an imminent risk to the patient's health

B.Standard SDT requires an order from the Prefect, whereas emergency SDT is ordered by the hospital director

C.Emergency SDT eliminates the requirement for a third-party written request entirely

D.Standard SDT requires prior judicial approval by the Juge des libertés et de la détention before admission

Explanation: Under Article L. 3212-1 II 1° CSP, standard SDT requires a written request from a third party and two detailed medical certificates confirming psychiatric illness preventing consent and requiring continuous care; the first doctor must not be an employee of the admitting hospital. Under the emergency procedure (Article L. 3212-3 CSP), if there is an imminent risk to the patient's health, admission can be pronounced based on a single medical certificate that can emanate from a doctor practicing in the admitting establishment.

8Under Article L. 3211-12-1 of the Code de la santé publique, by which statutory deadline must the Juge des Libertés et de la Détention (JLD) rule on the continuation of full-time involuntary psychiatric hospitalization?

A.Within 48 hours of admission

B.Within 72 hours of admission

C.Before the 6th day of hospitalization

D.Before the expiration of a 12-day period following initial admission

Explanation: Under Article L. 3211-12-1 CSP (introduced following Constitutional Council decision n° 2010-71 QPC), full-time psychiatric care without consent (*hospitalisation complète sans consentement*) must be reviewed by the judicial authority. The hospital director (for SDT) or the Prefect (for SDRE) must refer the case to the JLD so that the judge can rule prior to the expiration of the 12th day of admission. If the JLD has not ruled within this 12-day window, the full-time involuntary measure is automatically lifted.

9When a psychiatric patient presents an imminent danger to their health (*péril imminent*) and no third party can be located, what procedure allows a hospital director to admit the patient under Article L. 3212-1 II 2° CSP?

A.The director may admit the patient without any medical certificate if the family cannot be reached promptly

B.The director admits the patient based on a single medical certificate from a physician outside the hospital establishment, while making all diligent efforts to inform the family within 24 hours

C.The director requires two concurring certificates, both written by physicians employed by the admitting establishment

D.The director may use the procedure only after the mayor issues an emergency public-order order

Explanation: Article L. 3212-1 II 2° CSP establishes the *procédure de péril imminent*. When psychiatric disorders make consent impossible and there is an imminent danger to the person's life or integrity, and despite diligent efforts no third party can be contacted to formulate a request, the hospital director may pronounce admission based on a single medical certificate from a doctor who must be external to the admitting establishment. The director must notify the patient's family or *personne de confiance* within 24 hours.

10If a lucid, competent adult patient refuses a clinically indicated life-saving blood transfusion in an emergency department, what is the legal obligation of the hospital physician under Article L. 1111-4 CSP?

A.The physician must immediately seek a court order from the public prosecutor to perform the transfusion

B.The physician may unilaterally override the refusal without informing the patient once life is threatened

C.The physician must respect the patient's refusal after informing them fully of the consequences and vital risks, while seeking to convince them and delivering palliative care

D.The physician must discharge the patient immediately for non-compliance

Explanation: Under Article L. 1111-4 of the Code de la santé publique, every competent individual has the fundamental right to refuse medical investigations or treatments. When a patient refuses a life-saving treatment, the physician must respect their will after having done everything possible to convince the patient of the necessity of the care, fully detailing the vital consequences, and documenting this informed refusal in the medical record. The physician must continue to provide supportive and palliative care and cannot abandon the patient.

About the Directeur d'Hôpital (EHESP / CNG) Exam

The Directeur d'Hôpital (DH) corps is a prestigious Category A+ senior executive corps within the French Hospital Civil Service (Fonction Publique Hospitalière - FPH). Governed by the Code général de la fonction publique and the Code de la santé publique, hospital directors serve as chief executive officers (directeurs généraux / directeurs) or senior executives of Public Health Establishments (Établissements Publics de Santé - EPS), including Centres Hospitaliers Universitaires (CHU) and Centres Hospitaliers (CH). The hospital director legally represents the institution in all civil acts, acts as the authorizing officer for expenditures and receipts (ordonnateur des recettes et des dépenses), chairs the Directoire, and implements the strategic Projet d'Établissement within the framework of territorial health contracts (CPOM) contracted with the Agence Régionale de Santé (ARS). Successful laureates undergo an intensive 24-month salaried training program at the École des Hautes Études en Santé Publique (EHESP) in Rennes, alternating academic coursework with in-depth hospital managerial internships before titularization.

Exam sponsor: Centre National de Gestion (CNG) / École des Hautes Études en Santé Publique (EHESP). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

For the external route under the Arrêté du 19 juin 2024 as amended, written admissibility has four papers: a 5-hour reflection note on public health, environmental health and social protection (coef 2); a 5-hour synthesis-and-proposals note on hospital organization and management (coef 5); a 4-hour dossier-based composition in public law, public finance or economics; and a 4-hour dossier-based composition in public health, hospital law, health economics, or social-security/social-assistance law. The last two are chosen as major (coef 4) and minor (coef 2). Admission comprises a 45-minute collective professional exercise including individual debrief (coef 5), a 30-minute jury interview (coef 5), and a 15-minute English test after 15 minutes' preparation (coef 1).

Time Limit

Written admissibility: 18 hours across four papers; admission: 45-minute collective exercise + 30-minute interview + 15-minute English test

Passing Score

Competitive rank-based list; 97 places were opened for 2026. A mark below 5/20 may be accepted only by a reasoned jury decision; written admissibility requires at least 130 weighted points.

Exam / Certification Fees

Free / No examination fee

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

30%

Système de santé, santé publique et législation hospitalière

Code de la santé publique, ARS roles and territorial health projects (PRS), hospital missions, patient rights, consent, access to medical records, care safety, pharmacovigilance, and administrative liability.

25%

Gestion financière et budgétaire hospitalière

Budgetary framework (EPRD, PGFP, RIA), financing mechanisms (T2A, MIGAC, Ségur investments), cash management, investment amortizations, financial ratio analysis, and public hospital accounting (M21/M22).

25%

Ressources humaines et gouvernance dans la FPH

Code général de la fonction publique, hospital civil service rights and duties, statutory bodies (CSE, CAP, CCP, directoire, CME), medical staff statutes (praticiens hospitaliers), social dialogue, and working time organization.

20%

Stratégie hospitalière, coopération (GHT) et management public

Territorial hospital groups (GHT), project d'établissement, healthcare quality indicators and HAS certification, shared procurement, change management, crisis coordination, and integration with medico-social actors.

Preparing for the Directeur d'Hôpital (EHESP / CNG) Exam

What You Need to Know

Passing score: Competitive rank-based list; 97 places were opened for 2026. A mark below 5/20 may be accepted only by a reasoned jury decision; written admissibility requires at least 130 weighted points.
Assessment: For the external route under the Arrêté du 19 juin 2024 as amended, written admissibility has four papers: a 5-hour reflection note on public health, environmental health and social protection (coef 2); a 5-hour synthesis-and-proposals note on hospital organization and management (coef 5); a 4-hour dossier-based composition in public law, public finance or economics; and a 4-hour dossier-based composition in public health, hospital law, health economics, or social-security/social-assistance law. The last two are chosen as major (coef 4) and minor (coef 2). Admission comprises a 45-minute collective professional exercise including individual debrief (coef 5), a 30-minute jury interview (coef 5), and a 15-minute English test after 15 minutes' preparation (coef 1).
Time limit: Written admissibility: 18 hours across four papers; admission: 45-minute collective exercise + 30-minute interview + 15-minute English test
Exam / certification fees: Free / No examination fee Official sources

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Directeur d'Hôpital (EHESP / CNG): Suggested Study Strategy

1Master the distinction between the ordonnateur (the hospital director) and the comptable public (the public accountant) under the principle of separation of duties.

2Thoroughly memorize the components of the EPRD: the three expenditure and revenue sections (CRP, CRT, CRPA) and the multi-year investment plan (PGFP).

3Understand the governance interplay between the Directoire (decision-making executive body), the Conseil de Surveillance (deliberative and oversight body), and the CME (medical consultative body).

4Study recent legislative reforms including the Loi Rist (medical interim pay caps), the Ségur de la santé investments, and the 2024 Arrêté restructuring the entrance competition.

5Practice timing and structure for the 5-hour Note de Synthèse, ensuring a balanced 2-part, 2-subpart plan that directly answers the operational administrative brief.

Frequently Asked Questions

What is the role and legal authority of a French Directeur d'Hôpital?

Under Article L. 6143-7 of the Code de la santé publique, the Directeur d'Hôpital is the legal representative and chief executive of the public health establishment. The director exercises executive management, chairs the Directoire, prepares and executes the EPRD budget as authorizing officer (ordonnateur), holds appointing authority for non-medical personnel, and represents the hospital in judicial and legal proceedings.

What are the eligibility requirements for the three concours tracks?

The external route accepts the diploma required for the external INSP competition—at least a Licence/Bac+3 (Level 6)—or a qualifying equivalent. The internal route requires at least four years of public service; a third-concours route is also provided by the governing statute.

How is the written admissibility stage evaluated under the Arrêté du 19 juin 2024?

The external written stage has four papers: two five-hour notes (reflection, then hospital synthesis/proposals) and two four-hour dossier-based compositions, one in a public-law/finance/economics subject group and one in a health/hospital/social-protection subject group. The candidate designates one composition as major and the other as minor.

What occurs after successfully passing the competitive entrance examination?

Laureates are appointed as Élèves Directeurs d'Hôpital and enter a 24-month paid professional management curriculum at the École des Hautes Études en Santé Publique (EHESP) in Rennes. The curriculum alternates core executive seminars with extensive management internships in French and international healthcare establishments, culminating in official titularization into the Category A+ hospital director corps.

What is the passing score and how is admission determined?

Admission is competitive and rank-based within the annual quota; 97 places were opened for 2026. Written admissibility requires at least 130 weighted points. A score below 5/20 normally prevents admissibility or admission, although the current rule permits a reasoned jury decision.