France

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Health systems in transition
France
At the regional level, the density of health care professionals is characterized
by wide disparities that are roughly similar across the different health care
professions, although of differing magnitude. The Parisian and the southeastern
regions (Île-de-France and Provence–Alpes–Côte-d’Azur) have the highest
density of health care personnel, followed by the other southern regions, while
the northern and eastern regions suffer from a lack of such professionals. These
regional disparities are not related to population needs and consequently raise
equity issues that are likely to be exacerbated by anticipated demographic
trends (HCAAM, 2011) (see section 6.1.3).
Physicians
In 2013, there were a total of 218 296 doctors in France, almost equally divided
between GPs (47%) and specialists (53%). International comparisons suggest
there is currently no perceived shortage of physicians in France: with a density
of 319 physicians per 100 000 inhabitants, the number of doctors is close to the
EU28 average, lower than neighbouring countries such as Germany and Italy
and higher than other EU countries such as the United Kingdom (Fig. 4.4).
In the longer term, the picture is mixed. The retirement of large cohorts of
physicians who began working before the advent of the numerus clausus in
the early 1970s was expected to decrease significantly the number of active
physicians (Attal-Toubert & Vanderschelden, 2009). However, this decrease
may be offset by other trends. Since 2003, retired doctors have been permitted
to continue working in private practice, with earnings up to a fixed ceiling,
while still drawing their pensions. In 2009, the Social Security Finance Act
removed the ceiling, and subsequently the number of retirement-age physicians
who continued to practise medicine increased by 300% (CNOM, 2013). In
addition, the number of active physicians with foreign diplomas (European and
other foreign countries) has increased to 17835 (7.8% of registered physicians)
(see section 4.2.2).
Despite the fact that the overall number of physicians in France is currently
at an all-time high, geographic inequalities remain, and certain areas are
underserved, particularly isolated rural communities and disadvantaged
communities. The problem is particularly acute with respect to specialists, for
which an eight-fold difference between lowest and highest density departments
is seen. French doctors have long enjoyed the right to set up their practices
where they wish, and attempts to restrict freedom of settlement have faced
strong opposition from professional associations. Policies to address the
problem of so-called “medical deserts” have primarily focused on voluntary
incentives and have had limited effects, although the issue remains a political
priority (see section 6.1.3).