French Health Care System

The French healthcare system has been in place and has continued to evolve for more than one hundred years, and was classified the “best health system in the world” by the World Health Organization (WHO) in June 2000. It permits all French citizens access to treatment and to the latest discoveries in medical research. The success of the French health system is evidenced in the general health of the French population. Their life expectancy increases more than three months each year, and French women have the second highest life expectancy rate in the world.

The Healthcare System and its Users:

The French government provides a number of diverse and comprehensive healthcare rights. For more than 96 percent of the population, medical care is either entirely free or is reimbursed 100 percent. The French also have the right to choose among healthcare providers, regardless of their income level. For example, they can consult a variety of doctors and specialists or choose a public, private, university or general hospital. Moreover, the waiting lists for surgeries found in other government supported healthcare systems do not exist in France.

In France, health insurance is a branch of the Social Security system. It is funded by workers’ salaries (60 percent of the fund), by indirect taxes on alcohol and tobacco and by direct contribution paid by all revenue proportional to income, including retirement pensions and capital revenues. On the surface, it appears that health insurance reimburses medical care providers less in France than in other European countries. However, more than 80 percent of French people have supplemental insurance, often provided by their employers. The poorest have free universal healthcare, which is financed by taxes. Additionally, the treatment costs for those who suffer from long-term illnesses are completely reimbursed.

In July 2001, the government passed a law allowing the healthcare system to provide additional assistance to families who need help with daily tasks. On March 4, 2002, the government passed another law, establishing compensation for all medical-related accidents whether fault is found or not. These new rights were added to other long established rights, such as compensation payments in the case of pregnancy or disease prevention, medical care for workers and students, family planning, and systematic screening of certain diseases.

Organization of the Healthcare System:

Since 1996, the government has presented a law to parliament every year in order to finance social security. This document delineates the budget for next year’s national expenditures on health insurance. It additionally outlines goals to be achieved by the healthcare system during that year. However, these goals are broadly drawn as the actual healthcare budget varies according to revenue earned through taxes each year.

The government provides health insurance to three major groups of the population: salaried workers and their families, farmers, and artists and business professionals. Within each of these three groups, expenditures are divided by region and by type. Types of expenditures include general practitioners’ fees, specialists’ fees, medical prescriptions, public hospitals, private clinics, nursing professionals and sanitary transportation.

The state exercises its trusteeship through central, regional and departmental services. There are two large organizations that work under the Ministry of Health: General Health Management and Hospital and Healthcare Management.

Under the direction of these two large organizations are numerous health care facilities and agencies.

Hospitals and Clinics:

The Medical care establishment is made up of three types of institutions: public hospitals, private clinics and not-for-profit healthcare.

One thousand and thirty-two hospitals fall under the public hospital statute. Regional, university, local and general hospitals are included in this category and can trace their history back to the first era of Christianity. Public hospitals include a diverse group of institutions. For example, the Public Assistance Hospital of Paris employs over 80,000 people while in comparison the smallest local hospital employs less than 300. The Public Assistance Hospital of Paris is the most important and largest group of public hospitals. Created after the French Revolution, it became a hospital organization for the poor and for those involved in work related accidents in 1941. Today, this establishment is a complex organization that is responsible for a high standard of care, medical technology and research.

In all hospitals, doctors, biologists, and dentists are all paid as “hospital practitioners.” Advancement in the medical field is by seniority. Under the Title IV statute of the Civil Service, there is a nation-wide ranking system of hospital practitioners.

Since 1985, each public hospital has been financed primarily (91%) by endowment funding that is paid for by health insurance funds. Calculated by bases from previous years, these endowments are developed each year by a national rate manager. In effect, through the Medical Care Program of Information Systems, it is possible to calculate identical activities, relative productivity of each establishment and, in principle, adjust endowments. The national rate is calculated according to macroeconomic factors (inflation, growth, public deficit), politics (research of social peace in establishments) and, very rarely, medical considerations (financing of new technologies). Hospitals are all under the same regulations. For instance, the Ministry of Health nominates the heads of all hospital services.

Private clinics have quite a different history from public hospitals. They were started by surgeons and obstetricians and eventually evolved into private hospitals. A 1991 law requires all doctors in private clinics to share medical files with their colleagues and to create a Medical Care Commission to form evaluation procedures.

Another sector of the French healthcare system consists of not-for-profit private hospitals. These hospitals were originally denominational and currently make up 14% of the inpatient services among French Medical Care Institutions.

They are financed through endowments like public hospitals, but have the right to privacy like private clinics. The cooperation between the public and private sector in the French healthcare system is a positive feature that allows citizens to avoid waiting lists for surgeries, which are often associated with socialized medicine. Indeed, private medical care in France is particularly active in treating more than 50% of surgeries and more than 60% of cancer cases. This unique combination of government financed medical care and private medical services produces a health care system that is open to all and provides the latest in medical technology and treatment.

Principle Public Health Agencies

 National Institute of Health: created in 1998 and monitors public health. Also alerts the public to emerging health risks and takes appropriate action to guard against them.

 French Agency of Health Safety of Health Products: created in 1998 and has a mission of guaranteed independence, scientific competency and study of administrative efficiency. Additionally does research on therapeutic properties, usage of medicines and on health related products. Also participates in the application of laws and rules to the different commercial processes of health and cosmetic related processes. ? French Agency of Food Health Safety: created in 1998 and in charge of evaluating health and nutritional risks present in food for humans and animals.

 Agency of Environmental Health Safety: created in 2000 and in charge of coordinating expertise on the risks to the environment.

 French Institute of Blood: a public establishment of the state that succeeded the Blood Agency in 1992. Oversees the need of blood, guarantees a safe system of blood transfusion within the French healthcare system and works towards adapting transfusion systems according to current research in this area.

 French Institute of Transplants: established in 1994; coordinates transplant-related activities and involved in international transplant exchanges. Also collects information necessary to evaluate the quality of immunology pairing and gives opinions on procedures and activities relevant to the transplant process.