France

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Health systems in transition
France
The continuity of care system is designed to provide a timely and appropriate
response to patient needs at night and on weekends or public holidays when
ambulatory practices are closed. The system, which now falls under the remit
of the ARSs, relies on GPs who are on-call on a voluntary basis and are
paid allowances.
The 750 emergency care structures (structure des urgences) situated in
655 hospitals (76% public, 6% non-profit-making and 18% private) are the
cornerstone of the French emergency care system. Certain hospitals have
several emergency structures, and overall 85% are general units and 15%
paediatric units. They are subject to authorization by the ARSs.
Concerns regarding the system of emergency care centre upon the
increasing workload for hospital emergency departments, particularly because
of the ageing population and the growing number of visits by patients who
could be treated more efficiently in other settings. The number of doctors
volunteering to be on-call in the continuity of care system has diminished,
thereby weakening coverage and shifting a growing share of the burden to
hospital emergency services (Cour des comptes, 2013c). Because of these trends,
there is an increasing emphasis on alternatives to traditional emergency care
settings. For example, the number of urgent ambulatory care centres (maisons
médicales de garde) providing after-hours care without an appointment has
increased over the past 10 years, from 98 in 2003 to 369 in 2013, through
expanded public financial incentives. Box 5.1 illustrates the typical pathway for
someone needing to seek care, here a person experiencing typical symptoms
of a heart attack.
5.6 Pharmaceutical care
France is the third largest European producer of pharmaceutical products and
one of the principal exporters worldwide. The French population is among
the largest consumers of pharmaceutical drugs. While the growth rate of
the pharmaceutical market has slowed in recent years and showed a slight
decrease in 2012, sales of certain classes of drug continue to grow. Recent
reforms targeting consumption include de-listing drugs with insufficient or
low SMR, incentives for prescription of generic drugs and efforts to reduce the
inappropriate prescription and overuse of antibiotics.