1. Overview of Health Care System in France
- 1.1. System Under Pressure
- 1.2. Health Insurance System
1.1. L'Assurance Maladie - Under Pressure
The system of health care in France is known as l'assurance maladie, or the Sécu, an abbreviation of securité-sociale, altough the latter term is often also used to refer more generally to the system of social security in France.
It is often rightly praised for the quality of the treatment and the level accessibility it offers to patients.
France certainly spends a lot of money on health, around 10% of gross national income, one of the highest rates in the world.
Perhaps as a result of this expenditure the French enjoy a life expectancy only exceeded by that of the Japanese!
Nevetheless, the system is under severe financial pressure, there is a growing shortage of suitable staff in many regions, and a higher proportion of the running costs are having to be picked up by patients.
At an institutional level the organisation and financing of the system is complex and is often characterised by high levels of tension between the various parts of the system.
Most health professionals who work outside of hospitals are self-employed and depend for their income on fee paying patients whose costs are reimbursed by the social security and voluntary health insurance systems.
Patients, in turn, have been allowed to have unrestricted access to doctors and specialists with the result that no-one in the health system has had any particular incentive to keep down costs.
Since 2005 the government has introduced a series of reforms, the whole purpose of which is to increase efficiency and drive down costs. These reforms are on-going.
Social security health contributions have been increased, as have fees for medical consultations, whilst reimbursement levels have been reduced.
At an administrative level, everyone is now required to register with a doctor; medical records for patients are to be introduced, and there have been some reforms to the institutional structure.
Continuing concern about rising costs has resulted in stronger controls by government limiting the freedom of professionals and patients and controls on the prices of drugs.
To anyone from outside of France some of these reforms may appear logical and long overdue, but there is widespread concern in France amongst the public and the medical profession about their impact.
Many health professionals consider the changes are too bureaucratic, and there are many commentators who consider that the costs of health care are going to increasingly fall upon poorer members of the community and those who are ill.
In short, like most other developed nations, France can no longer afford its health service.
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Public Services in France