The current situation of cost control relative to health expenditure forces hospitals to consider their management style. The question of the efficiency of the health system is thus raised. Does formalization through contracts offer the beginnings of an answer? Apparently, according to the growth of such approaches in numerous public health establishments. This marks a move towards a new form of “medico-administrative” governance. Through this article, I suggest a basic challenge to the contractual method, its issues, and its limits. In particular, I offer a projective approach to the consequences of this management method on the “health executive” function. The point here is to highlight the fact that, if the health executive’s place is acknowledged in the formalized internal contracts, their skills will increase the value of the contractual process. Indeed, such questions are all the more important because the ordinance of May 2, 2005, which includes “various arrangements relative to the functioning of public health establishments and modifications of the public health code,” stipulates that public hospitals should use internal formalization through contracts to set up centers before December 31, 2006 at the latest.