France

5. Provision of services
5. Provision of services
Both public and private providers deliver health care to the French
population. Primary care is mostly delivered in the ambulatory care
sector by self-employed professionals, while secondary care can be
delivered both in the ambulatory and the hospital setting. From the late 1990s,
GPs have gained a major role in the coordination of care, with the implementation
of a semi-gatekeeping system that provides incentives to people to visit their
GP prior to consulting a specialist. Drugs are dispensed by self-employed
pharmacists, while the price of drugs, as in most countries in the OECD, is set
administratively for all drugs covered by SHI. France is the third largest market
for pharmaceutical drugs in the world. Hospital care is delivered by public,
private non-profit-making and private profit-making hospitals. Long-term care
for the elderly and disabled is provided through both residential care and home
care. Mental health care is delivered by both the health sector and the social and
health care sector. As in many other European countries, mental health care
policy in France during the second half of the 20th century was influenced by
a general movement towards community-based organization of mental health
care services – the so-called “deinstitutionalization” process.
5.1 Public health
Public health policy and practice in France have historically been difficult to
describe because they involve numerous actors and sources of funding. Further,
large discrepancies exist between legislative texts and actual practice, which
relies on the initiative of local actors. Nevertheless, reforms starting in 2004
have resulted in a more clearly structured organization of the field.