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128 Health systems in transition France Fig. 5.1 Outpatient contacts per person per year in the WHO European Region, 2013 Western Europe Germany Turkey Belgium Spain Austria Italy Luxembourg France Netherlands Israel Iceland United Kingdom Denmark Norway Portugal Greece Switzerland Ireland Sweden Finland Cyprus 2.9 2.6 2.4 5.0 4.6 4.2 4.1 4.0 3.9 3.8 7.4 7.4 6.8 6.8 6.5 6.4 6.2 6.2 6.0 8.2 9.9 Central and south-eastern Europe Hungary Czech Republic Slovakia Lithuania Serbia Poland TFYR Macedonia Latvia Slovenia Estonia Croatia Bosnia and Herzegovina Bulgaria Romania Montenegro Albania 2.5 8.1 7.5 7.1 7.0 7.0 6.5 6.4 6.1 5.5 5.4 4.8 4.4 11.7 11.1 11.0 CIS Belarus Ukraine Russian Federation Uzbekistan Kazakhstan Republic of Moldova Tajikistan Azerbaijan Armenia Turkmenistan Kyrgyzstan Georgia 4.5 4.3 3.8 3.4 3.3 2.7 6.7 6.5 9.5 9.0 10.5 12.7 Averages CIS Eur-B+C European Region EU members since May 2004 CARK EU EU members before May 2004 Eur-A 7.6 7.5 6.9 6.9 6.8 6.8 8.9 8.3 0 3 6 9 12 15 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.
Health systems in transition France 129 A small part of outpatient care is provided by salaried professionals working in public sector hospitals or health centres. Outpatient care and examinations in hospitals represent about 15% of all outpatient consultations. Around 1700 health centres, usually run by local authorities or mutual insurance associations, along with some organizations offering free treatment to disadvantaged groups, are also active in the delivery of outpatient care, albeit on a marginal basis. These centres are either specialized centres involved in nursing (40%), dental care (25%) or general practice (about 5%) activities, or integrated centres providing all kinds of ambulatory care (about 30%). Patients are free to choose their health care providers, although the level of SHI coverage for physician visits depends upon whether the rules of the gatekeeping structure are followed (see section 2.9.2). Access to physician care, both in terms of proximity and finance, is an issue in some areas and with respect to certain specialties. Doctors are free to choose where they wish to practise, and geographical disparities in the distribution of doctors have long existed (see section 4.2). Moreover, certain doctors practise in Sector 2 and, therefore, may engage in extra-billing beyond the official SHI tariffs, which has implications with respect to financial access to care. Nursing care is mainly provided by self-employed nurses. Nursing and home care of patients makes up two-thirds of their work, with another third devoted to technical activities such as performing injections or intravascular perfusions. Since 1981, SSIAD units have been developed in the health and social care sector for disabled and frail elderly people. They are mainly staffed by salaried nursing auxiliaries, with nurses participating in the delivery of care to a lesser extent. Substantial geographical inequities of access to nursing care exist (see section 4.2.1). Almost all dentists are self-employed in ambulatory practices, as are the majority of physiotherapists, speech therapists and orthoptists. Regarding diagnostic procedures, these are mainly performed within private laboratories owned by specialized physicians or pharmacists or in imaging centres owned by specialized physicians. About 3600 privately owned laboratories carry out biological testing procedures. These procedures may also be carried out in hospitals. Finally, there are some 22 000 pharmacies, which provide advice and health information in addition to dispensing drugs, small medical devices and bandages. Under the 2009 HPST Act, the role of pharmacists within the primary care system was acknowledged and formalized. While geographic disparities exist for most health services, this is not the case for pharmacies, which are readily accessible by the entire population and often constitute the first contact with the health care system.
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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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