The paper is a very preliminary step to analyse and discuss theses questions in the specific field of the health care sector, in a comparative perspective between Germany and France. It is based on data and preliminary case studies gathered in the framework of the “Future of Low Wage Work in Europe” research, done in European countries for the Russell Sage Foundation. Focusing on the Hospital sector, and on low wage/low skilled occupations within the sector has advantages and difficulties. On the one hand, one can argue that the specificities of the sector (public activity, public regulations) are too high to arrive at conclusions on the process of change in the whole economy. But on the other hand, the health financing system and other recent developments exert similar pressures as in other industries and lead to similar reactions and changes in the competitive structures (section 1). And focusing on low level occupations allows us to escape (or to be at the margin) of the occupational and medical rules governing other occupations in the sector (such as doctors and nurses): it is the lowest segment of the hospitals labour force where hospitals compete on the labour market with other activities (cleaning, home personal care for example). A study of the low skill/low wage sector of the labour market also profits from the fact that this segment is often said to be more exposed to the change. Another advantage is that the high level of female employment in this industry is representative of one of the main changes within the employment structure, and of what is often regarded as the main deregulated (or at risk of deregulation) segment of the labour force. Section 2 will investigate the various institutional rules, which characterized the previous employment system within hospitals. Section 3 will present and discuss the main changes affecting the employment relationship and the way by which, in the two countries, institutional frameworks are transformed, bypassed and/or unchanging. We will particularly compare wage levels and structures and the proliferation of ‘atypical' employment.