Health technology assessment (HTA) informs public decision-making regarding the use of medical innovations. In France, the national health authority (Haute Autorité de santé, HAS) is the principal body responsible for these assessments. In hospitals, a specific form of HTA–hospital-based HTA (HB-HTA)–has been developed to evaluate technologies in their local context, contributing to better allocation of resources and judicious management of innovation. However, HB-HTA remains underdeveloped in France. In this context, round table no. 4 of the “ Ateliers de Giens ” (Giens Workshops), a meeting of experts from the fields of academia, medicine, hospital management and industry, looked at the obstacles and solutions that could enable HB-HTA structures in France to do more and do better. The round table identified several major findings that are hampering the development of HB-HTA. First, HB-HTA remains limited regarding its scope of application and number of potential beneficiaries. As a result, the activity suffers from a lack of recognition at an institutional and strategic level. The situation is further hampered by a marked lack of human, organizational and financial resources, as well as extremely limited dissemination of the findings, both internally and externally. Finally, the absence of harmonized assessment methods harms the informative value and impact of these procedures. To address these challenges, the round table formulated five recommendations: (1) expanding the uses of HB-HTA in the health system; (2) increasing recognition for HB-HTA by demonstrating its usefulness; (3) funding of HB-HTA pilot centers and creating the conditions for sustainable funding; (4) structuring the sharing of HB-HTA assessments; and (5) promoting a unified HB-HTA methodology and supporting the training of those involved.