France

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Health systems in transition
France
Nurses
Nurses and nursing aides form the two largest groups of health professionals
in France. In 2013, there were 595 594 nurses in France. With 1000 nurses per
100 000 inhabitants in 2013, the density of nurses in France is relatively low
compared with neighbouring European countries such as Germany, but higher
than the EU28 average (Fig. 4.4). However, this fact is difficult to interpret
given the differences in the scope of tasks performed by nurses and nursing
aides in different countries.
The number of nurses steadily increased between 1991 and 2013 at an average
growth rate of 3.0% per year (Eco-Santé, 2014), following a progressive increase
in the numerus clausus since 1993. However, this increase in the workforce has
not been sufficient to meet the rapidly increasing demand. Moreover, there are
large persisting geographical disparities in the density of self-employed nurses,
which parallel those observed for physicians (Sicart, 2013b).
Incentives to control the geographical distribution of nurses’ settlement of
a new practice have been set up under the 2007 agreement. Limits have been
established in areas with high density, and financial and material incentives are
offered to encourage new practices in underserved areas.
Nurses may specialize in various fields, including paediatrics, anaesthesia
and surgery.
Between 2009 and 2011, an average of 513 000 nursing aides were
employed in health care institutions, providing routine nursing care such as
maintaining personal hygiene and assistance with essential bodily functions.
Their involvement remains marginal in outpatient settings, where they mainly
work in SSIAD (see section 5.8.1) under the auspices of specific services that
employ them.
Midwives
Midwifery is a distinct medical profession, with field of practice restricted to
non-pathological situations. There were 20 035 midwives practising in France
in 2013. While recent years have seen an increase in the share of self-employed
midwives, geographic disparities are less of an issue than among physicians
and nurses, because the majority of midwives are hospital based. Midwives
in the ambulatory sector play a key role in facilitating shorter stays in
maternity hospitals.