Health in France
Health in France
The right to the protection of health features in Article 11 of the preamble to the 1946 French Constitution. In 2000, WHO declared the French system to be one of the best healthcare systems in the world. France’s health policy, conducted under the responsibility of central government, covers a range of healthcare and prevention plans to protect and improve the population’s health (Act 2004-806 of 9 August 2004 on the public health policy).
THE FRENCH POPULATION’S HEALTH
French men and women have a combined life expectancy at birth of 78 years. The French are in good health even though the premature death rate (death before 65 years old) is one of the highest in Europe and social and regional inequalities in access to treatment and prevention persist despite solidarity mechanisms. Cardiovascular illnesses and tumours are the two main causes of death. However, France posts a number of positive indicators:
· Infant mortality is very low;
· Life expectancy at 65 years old, i.e. the number of additional years individuals celebrating their 65th birthday can hope to live, is very high at over 16 years for men and 20 years for women. The values observed in France are the highest in the European Union.
· The death rate due to cardiovascular illnesses is one of the lowest in the European Union. Source : La santé en France, 2002
THE COST OF HEALTH
In 2005, national health expenditure stood at €181 billion or 10.6% of gross domestic product, ranking France fourth among the 23 Organisation for Economic Cooperation and Development (OECD) countries behind the United States (15.3%), Switzerland (11.6%) and Germany (10.9%).
Current health expenditure, which includes all expenditure incurred by the social security system, central government, local authorities, the supplementary insurance bodies and households, stood at €190.5 billion in 2005 representing €3,038 per capita. The share of current health expenditure in GDP places France in 11th place among the OECD countries.
The consumption of medical goods and services includes public and private in-patient care (44.5%); out-patient care – doctors, dentists, paramedics and laboratory analyses – (27.1%); medicines (20.8%); patient transport and other medical goods – optical, prostheses, supplies and dressings. Cardiovascular diseases represent the most expensive pathology (12.6%) followed by mental problems (10.6%) and osteoarticular disorders (9%). Mouth and teeth complaints dominate out-patient care in terms of cost (28.3%).
THE HEALTHCARE SUPPLY
The French healthcare system is pluralistic since private and public structures coexist side by side. Patients choose their practitioners and freely access the different types of hospitals.
Most of the out-patient care is provided by practitioners – doctors, nurses, dentists, etc. – who are self-employed professionals.
The French hospital system is made up of public and private institutions:
· The public institutions include the regional hospitals (CHRs) and the local hospitals. The 29 regional hospitals, including 27 teaching and research hospitals, provide specialised care. The local hospitals provide routine healthcare;
· The private institutions are profit making and non-profit making. The non-profit institutions are run using the same management system as the public institutions and have the same public service brief.
In 2005, there were 2,891 health institutions with 450,726 beds (full-time in-patient care) and 49,732 places (partial in-patient care lasting less than one day). Source : Insee santé (French National Institute of Statistics and Economic Studies).
In 2004, there were 11.4 million full-time in-patients and 11.6 million patients taken in for partial in-patient care, representing a total of 23 million. Source : Drees (French Directorate for Research, Studies, Evaluation and Statistics), Etudes et résultats n°456 , December 2005.
HEALTH INSURANCE
The health insurance system was established by Bylaw 45-2250 of 4 October 1945 to offer all French citizens equality of access to healthcare, regardless of their income level. The health insurance system – also known as compulsory insurance to distinguish it from supplementary insurance – comprises a number of schemes:
· The general social security scheme, which covers the majority of beneficiaries including private-sector wage-earners and pensioners; Act 99-641 of 27 July 1999 introduced universal health insurance (CMU) for this scheme to cover the most underprivileged individuals;
· The specific schemes, which cover certain professions such as farmers and craftspeople;
· Some one hundred special schemes, which cover mainly civil servants, certain public sector employees and religious ministers.
In 2005, the health insurance system covered 77.1% of health expenditure. The supplementary insurance bodies (mutual health insurance companies, insurance firms and provident institutions) picked up 12% of the remaining share, the households 8.7%, and central and local government 1.3%.
RECENT FRENCH HEALTH SYSTEM REFORMS
Recent health policy developments include:
· Act 2004-810 of 13 August 2004 on the health insurance reform, based on three main pillars:
. The rationalisation of healthcare: obligation to choose a regular GP, personalised medical files and introduction of a new Carte Vitale (a smart card containing the health beneficiary’s details) from 2007 to 2010.
. A complementary contribution by each beneficiary: contribution of one nonreimbursable euro on each visit to a GP or specialist and flat-rate hospital contribution of €15.
. Combating fraud: more stringent checks on sick leave and Carte Vitale bearing an ID photo.
· Act 2004-806 of 9 August 2004 on the public health policy, which introduces five major five-year programmes and regional public health policy management. The five programmes for 2004-2008 are: . The cancer plan, . The plan to combat violence, abuse, risk behaviour and addictive behaviour, . The plan to curb the impact of environmental factors on health, . The plan to improve the quality of life of patients with chronic illnesses, . The plan to improve treatment and care for patients with rare diseases.
· The ’2012 Hospital Plan’ endowed with 10 billion euros is to enable the launching of new investments with three priorities: the strengthening of complementarity between hospitals located in one territory, the upgrading of security standards, and the computerization of the hospital system.
· Act 2002-303 of 4 March 2002 on patients’ rights covering pain relief, respect for the patient’s dignity, provision of information to the patient, patient consent and compensation for serious medical accidents.
These figures have been provided by the French Directorate for Research, Studies, Evaluation and Statistics (DREES) and the Ministry of Health and Solidarity.
To find out more
ON HEALTH IN FRANCE
. Preamble to the 1946 French Constitution:
http://www.conseil-constitutionnel.fr/textes/p1946.htm .
The World Health Report 2000 - Health Systems: Improving Performance
http://www.who.int/whr/2000/fr/index.html
. Les comptes nationaux de la santé en 2005 (The 2005 national health accounts)/DREES, Annie FENINA and Yves GEFFROY
http://www.sante.gouv.fr/drees/seriestat/pdf/seriestat100.pdf
. Les comptes nationaux de la santé en 2005 (synthèse) (The 2005 national health accounts – summary), DREES Etudes et Résultats No. 505, July 2006/Annie FENINA and Yves GEFFROY
http://www.sante.gouv.fr/drees/etude-resultat/er505/er505.pdf
. INSEE key figures on health in France
http://www.insee.fr/fr/ffc/accueil_ffc.asp?theme=6
. La santé en France/High Committee for Public Health, 2002 (three-year edition)
http://hcsp.ensp.fr/hcspi/docspdf/hcsp/hc001174.pdf
English version: Health in France, 2002
http://hcsp.ensp.fr/hcspi/docspdf/hcsp/hc001521.pdf
. Le système de santé en France /High Committee for Public Health, 2000
http://www.sante.gouv.fr/htm/minister/systsan.htm
. 2004 ministerial activity report from the Ministry of Health and Solidarity (in French)
http://www.sante.gouv.fr/ministere/ram2004/rapport.pdf .
HEALTH section on the Vie Publique website (Documentation Française)
http://www.vie-publique.fr/th/acces-thematique/sante.html
ON THE HEALTH INSURANCE SYSTEM:
. Report on the future of the health insurance system (in French), Documentation Française website:
http://www.ladocumentationfrancaise.fr/dossiers/assurance-maladie-france/
. Health insurance: Ensuring the future of the French healthcare system
http://www.premierministre.gouv.fr/en/information/reports_98/health_insurance_ensuring_the_100/
. Seguro de enfermedad: crear un futuro para el sistema sanitario
http://www.premierministre.gouv.fr/es/information/temas_actualidad_124/seguro_enfermedad_crear_un_343/
ON THE HOSPITALS:
. The 2012 hospitals plan
http://www.sante.gouv.fr/htm/actu/hopital_2012/sommaire.htm
. Report on the hospitals policy (1970-2005), Documentation Française, Vie Publique website http://www.vie-publique.fr/politiques-publiques/politique-hospitaliere/index/
. Les établissements de santé: un panorama pour l’année 2003 (The health institutions: an overview for 2003), taken from the annual health institutions statistics (SAE 2003) [http://www.sae-diffusion.sante.gouv.fr/dwd_dwshelp1.aspx
ON PATIENTS’ RIGHTS:
. Report on patients’ rights, Documentation Française website:
http://www.ladocumentationfrancaise.fr/dossiers/droits-malades/index.shtml
. Report on patients’ rights and the quality of the healthcare system, French Ministry of Health website:
http://www.sante.gouv.fr/htm/pointsur/malades/sommaire.htm
© Ministère des Affaires étrangères / French Ministry of Foreign Affairs, 2007
Public health and prevention in France
THE PRINCIPLES OF THE PREVENTION POLICY
Health equality for French citizens is based on equal access to healthcare and prevention. Prevention consists as much of promoting early access to care as curbing destructive behaviour and exposure to toxic agents. For example, of the €10.5 billion allocated for prevention in France in 2002, accounting for 6.4% of current health expenditure*, half was earmarked for disease prevention, one-quarter for screening and testing, and onequarter to cover risk factors.
Only prevention can protect against diseases for which there is no effective treatment. This is why France has stepped up its prevention policy in recent years to improve the French population’s health, reduce premature death (before 65 years old) and combat health inequalities between regions, genders and socio-economic groups. This prevention action has been the main thrust of the government’s health policy and its associated multiannual health plans since Act 2004-806 of 9 August 2004 on the public health policy.
The National Institute for Prevention and Health Education (INPES) implements prevention and health education policies as part of the public health policy guidelines.
In 2006, the Health Minister launched the General Assembly on Prevention to analyse the prevention actions in force and define guidelines based on the citizens’ needs.
THE OTHER ASPECTS OF PREVENTION
The immunisation policy is a major pillar of the national prevention strategy. Some vaccinations are compulsory for the entire population: diphtheria, tetanus, poliomyelitis and the BCG against tuberculosis (Public Health Code, articles L. 3111-1, L. 3111-2, L. 3111-3 and L. 3112-1).
Health and safety is another hinge pin of the public health policy. It is designed to protect against all the risks likely to affect the population’s health: risks associated with healthcare, health products, work, the natural environment and food.
THE MULTIANNUAL HEALTH PLANS
Once every five years, strategic public health plans are defined to cover the main health concerns, which are identified from analyses conducted by the High Council for Public Health and recent WHO studies. The report appended to Act 2004-806 of 9 August 2004 on the public health policy defines five strategic priorities for the 2004-2008 period:
· Cancer
· Health and the environment
· Rare diseases (including the Alzheimer’s Plan)
· Violence, abuse, risk behaviour and addictive behaviour
· Chronic illnesses and the quality of life
These five strategic plans are broken down into 100 achievable targets based on current expertise and resources. The programmes focus on determinants (such as tobacco and alcohol consumption), pathologies and population groups (seniors, pupils and prisoners). These plans are discussed in consultations headed by the National Health Council, an advisory body that issues opinions and makes proposals to the government. Once passed by Parliament, the public health targets are binding and are evaluated at the end of the five-year period.
These major strategic plans are combined with other national and regional programmes. For example, the national plan to limit the health impact of violence and abuse includes the road traffic injury prevention programme, the mental health plan and the programme on addictive behaviour for the 2007-2011 period. Among the other major national programmes are the 2006- 2010 pain relief plan and the 2006-2010 health and nutrition programme.
IMPLEMENTATION OF THE PUBLIC HEALTH POLICY AT REGIONAL LEVEL
The public health policy is defined at national level and implemented at regional level. The region’s prefect draws up a regional public health plan in keeping with the national plan, but including regional particularities following consultations with local authority representatives sitting on the regional health council (Article L. 1411-10 of the Public Health Code). Specific actions may be taken to address these particularities in accordance with procedures laid down by decree. The regional public health plan is applied by the regional public health group made up of the public health sector institutions, the regional hospitals agency, the regional health insurance fund, the region, and the départements and local government bodies should these latter two opt to be involved.
* Definition of current health expenditure: all expenditure incurred by the social security system, central government, the local authorities, supplementary insurance bodies and the households. It covers total medical consumption, statutory sick pay, subsidies received by the health system and treated as expenditure, collective prevention, medical research and medical training expenditure, and health management outlays (definition: DREES – French Directorate for Research, Studies, Evaluation and Statistics).
To find out more
ACT 2004-806 OF 9 AUGUST 2004 ON THE PUBLIC HEALTH POLICY
Report appended to Act 2004-806 of 9 August 2004 on the public health policy
http://www.legifrance.gouv.fr/texteconsolide/SPECV.htm
Informative brochure on the aims and implications of the public health policy act of 9 August 2004, produced by the Directorate General for Health
http://www.sante.gouv.fr/cdrom_lpsp/pdf/Brochure_dgs.pdf
PREVENTION IN THE FRENCH HEALTH SYSTEM
National Institute for Prevention and Health Education (INPES)
http://www.inpes.fr
Les dépenses de prévention et les dépenses de soins par pathologie en France (Prevention expenditure and healthcare expenditure by pathology in France)/Annie FENINA, Yves GEFFROY and Corinne MINC, DREES Etudes et Résultats, No. 504, July 2006.
http://www.sante.gouv.fr/drees/etude-resultat/er504/er504.pdf
Dossier santé : des objectifs et des moyens adaptés aux enjeux de demain : une logique de prevention (Health: targets and resources adapted to tomorrow’s challenges: a prevention logic), French Prime Minister’s website
http://www.premier-ministre.gouv.fr/chantiers/sante_666/
Santé : disposer du meilleur système en matière de prevention (Health: having the best preventive system), French Prime Minister’s website
http://www.premierministre.gouv.fr/information/actualites_20/sante_disposer_meilleur_systeme_57060.html
Information on the General Assembly on Prevention: special section
http://www.sante.gouv.fr/htm/dossiers/prevention/sommaire.htm
La prévention en matière de santé (Health and prevention)/Economic and Social Council, Guy Robert, November 2003
http://www.ces.fr/rapport/doclon/03112624.pdf
La santé en France/High Committee for Public Health, 2002 (three-year edition)
http://hcsp.ensp.fr/hcspi/docspdf/hcsp/hc001174.pdf
Health in France, English version, 2002
http://hcsp.ensp.fr/hcspi/docspdf/hcsp/hc001521.pdf
NATIONAL PUBLIC HEALTH PLANS
Plan de lutte contre le cancer, French Prime Minister’s website
http://www.premier-ministre.gouv.fr/chantiers/cancer_673/
Cancer: A multi-year plan and strong mobilization – English version
http://www.premierministre.gouv.fr/en/chantiers/major_projects_94/multi_year_plan_and_55730.html
Cáncer : un plan plurianual y una movilización ejemplar – Spanish version
http://www.premierministre.gouv.fr/es/chantiers/las_grandes_obras_125/un_plan_plurianual_y_55739.html
Pain relief plan, French Prime Minister’s website
National health/environment plan: dossier
http://www.sante.gouv.fr/htm/dossiers/pnse/sommaire.htm
2006-2010 national health and nutrition programme: dossier
http://www.sante.gouv.fr/htm/pointsur/nutrition/sommaire.htm