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122 Health systems in transition <strong>France</strong> At the national level, the current system involves a number of institutions that provide multidisciplinary expertise in the field of health safety, two of which have broad remits covering many aspects of health safety: InVS, which is involved in surveillance, and INPES, which is involved in managing health crises and informing the population. Other specialized agencies provide expertise regarding specific types of risk and may exert policy enforcement duties (see section 2.3.3). At the local level, municipalities are legally responsible for monitoring and purifying the water supply, controlling air and noise pollution, waste disposal, protection against radiation, hygiene in residential areas, food hygiene and industrial hygiene. Municipalities lacking the resources to carry out these functions are supported by the ARSs and their territorial delegations. 5.1.1 Surveillance of environmental and communicable disease threats At the national level, the current system for the management of health risks involves a number of institutions that provide multidisciplinary and intersectoral expertise in the field of health safety (see sections 2.3.3, 2.5.5 and 2.6). On the one hand, there are specialized agencies that provide expertise regarding specific types of risk and may exert policy enforcement duties; on the other hand, two agencies have a broad remit that covers many aspects of health safety. The specialist agencies include ANSM, EPRUS, ANSES, IRSN and the French Biomedicine Agency. The two agencies with a broad remit are InVS and INPES. InVS has a mandate to monitor threats to population health, including infectious and chronic diseases and environmental and occupational health, as well as emerging threats of unknown origin that require continuous monitoring of health outcomes. InVS gathers surveillance data from various sources, including national monitoring systems that rely on networks of professionals, as well as a network of regional epidemiology units (cellules interregionales d’épidémiologie). It reports all new epidemiological threats to the Ministry in charge of Health. INPES plays a major role in all issues related to communication and health, including strategies for dissemination of health alerts to population groups. In order to increase effectiveness, the planned 2015 Health Reform Law (see section 6.2) intends to merge these two institutions into a single agency.
Health systems in transition <strong>France</strong> 123 The General Directorate of Health of the Ministry in charge of Health supervises the activity of the health agencies on a regular basis, issues regulations based on the advice provided by the agencies and deals with all emergencies regarding health safety. Moreover, the General Directorate of Health leads the Health Agency Networking Committee (Comité d’animation du système d’agences), a forum that brings together the directors of the major agencies involved in prevention and health security policy in order to develop a cohesive approach and strong leadership with respect to these policies. The Health Agency Networking Committee also includes HAS, HCSP, the National Institute for Medical Research (Institut national de la santé et de la recherche médicale) and the ARSs. 5.1.2 Occupational health Employers are responsible for ensuring compliance with hygiene and safety standards through a Committee for Hygiene, Safety and Working Conditions (Comité d’hygiène et de sécurité des conditions de travail) and occupational health services (Services de santé au travail; SSTs) in companies. The Committee for Hygiene, Safety and Working Conditions represents the company’s employees in all issues regarding work conditions and safety; it verifies that regulations are correctly applied and makes proposals to improve working conditions. The SSTs are run by occupational physicians and have a general remit to ensure that employees’ health is not altered by their work by confirming their ability to do their jobs, monitoring their health and ensuring that the exposure to risks in the workplace is within regulatory standards. There must be at least one occupational physician per 3300 workers. Large firms finance and host their own occupational medical services, whereas smaller firms are affiliated with external non-profit-making SSTs. Nationally, there are 953 occupational physicians working directly for firms and 4594 physicians working for external services covering multiple firms. The number of occupational physicians has diminished in recent years, with a nearly 10% decline from 2010 to 2011, largely through retirement, despite an increase in the number of internships offered for this discipline (IGAS, 2013a). At the national level, the ANSES is responsible for oversight of workplace safety. The 848 SSTs are subject to regional oversight. Two successive national plans for occupational health have focused on security, prevention and protection of workers’ health. The first (2005–2009) resulted in structural reforms, including the fusion of two antecedent agencies
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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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List of tables, figures and boxes L
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Abstract Abstract This analysis of
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1. Introduction 1. Introduction The
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3. Financing 3. Financing Health ca
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7. Assessment of the health system
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