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110 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).
Health systems in transition France 111 Fig. 4.4 Number of physicians and nurses per 100 000 population in the WHO European Region, 2013 Western Europe Monaco Switzerland Norway Denmark Iceland Finland Germany Ireland Luxembourg San Marino France Austria Belgium Netherlands United Kingdom Malta Portugal Italy Greece Spain Cyprus Israel Andorra Turkey Sweden Central and south-eastern Europe Lithuania Czech Republic Slovenia Hungary Estonia Croatia Serbia Slovakia Bulgaria Romania Latvia Poland Montenegro Bosnia and Herzegovina TFYR Macedonia Albania CIS Armenia Azerbaijan Belarus Georgia Kazakhstan Kyrgyzstan Republic of Moldova Russian Federation Tajikistan Turkmenistan Ukraine Uzbekistan 702.9 1614.4 404.6 1769.6 430.6 1720.9 362.4 1661.6 362.3 1626.8 302.4 1454.2 405.4 1319.4 269.3 1260.9 280.7 1230.1 506.1 876.5 319.0 999.7 499.0 803.1 295.2 968.9 328.8 855.6 278.0 870.3 346.2 744.2 426.1 629.3 390.0 634.2 619.0 378.6 381.3 532.4 322.2 518.0 325.3 504.1 315.6 369.0 175.9 253.7 400.7 427.7 785.3 368.9 841.3 263.0 833.4 320.9 659.7 328.3 648.4 303.3 658.5 310.0 632.2 300.1 607.8 397.7 491.8 248.4 580.8 319.1 508.1 221.4 580.3 215.4 551.8 187.9 544.6 275.4 414.2 128.0 506.2 278.4 498.7 344.4 662.0 393.8 1067.4 407.3 341.4 351.5 802.1 189.5 598.6 293.2 628.3 239.1 430.0 167.9 439.1 226.6 455.2 350.0 757.7 238.0 1121.0 Averages CARK CIS EU EU members before May 2004 EU members since May 2004 Eur-A Eur-B+C European Region 253.3 857.5 270.3 617.0 346.7 850.0 364.4 912.4 280.8 622.1 364.1 925.4 254.9 547.8 307.9 728.9 ■■■■■ Physicians per 100,000 ■■■■■ Nurses per 100,000 0 500 1000 1500 2000 2500 Source: WHO Regional Office for Europe, 2015. Notes: CARK: Central Asian Republics and Kazakhstan; CIS: Commonwealth of Independent States; Eur-A,B,C: Regions as in the WHO list of Member States, last available year; TFYR Macedonia: The former Yugoslav Republic of Macedonia.
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Contents Contents Preface
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Preface Preface The Health Systems
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Acknowledgements Acknowledgements T
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Abstract Abstract This analysis of
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1. Introduction 1. Introduction The
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