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150 Health systems in transition France Table 5.4 Institutions of the health and social sector that provide services to children with mental health-related disabilities: overall capacity and share of affected population served Institution Overall capacity (2010 or last year available) Percentage of children with mental health-related disabilities served (2010 or last year available) Educational centres for children suffering from mental 69 592 a 18.9 a disabilities (instituts médico-éducatifse) Institutions for children with multiple disabilities 5 637 a 4.1 a (etablissements pour enfants et adolescents polyhandicapés) Institutions for children with physical disabilities 7 505 a 2.7 a (instituts d’éducation motrice) Sensory training centres (instituts d’éducation sensorielle) 8 409 a 1.9 a Medico-psycho-educational centres (centres médico-psycho-pédagogiques) Therapeutic and educational centres (instituts thérapeutiques, educatifs et pédagogiques) Home care and education services (services d’éducation spéciale et de soins à domicile) Early social activity centres (centres d’action médico-sociale précoce) Temporary reception centres for disabled children (etablissements d’accueil temporaire d’enfants handicapés) Experimental centres for disabled children (etablissements expérimentaux pour l’enfance handicapée) 2 779 080 (consultations) 175 160 (active files) a 100.0 (2003) b 14 984 a 93.7 a 43 556 a 4.6 a 1 238 710 (consultations) 20.0 (2008) c 65 010 (active files) 284 d 6.0 d 1 155 a 26.50 a Sources: a DREES, 2013d; b Coldefy, 2005; c CNSA, 2008; d DREES, 2008. Critics of the mental health care system cite the lack of coordination among the health and social care sector, self-employed medical professionals and specialists and the private profit-making sector; the significant geographical inequalities regarding available resources; and the excess capacity for full-time hospitalization. These problems stem in part from the nature of psychiatric research in France, which traditionally has been monodisciplinary. In recent years, policy-makers have begun to recognize the need to develop a multidisciplinary research approach, with a particular focus on social sciences and health services, to better coordinate the different mental health actors and to develop smoother patient care pathways (Couty, 2009).
Health systems in transition France 151 5.12 Dental care Dental care in France is provided mainly by self-employed dentists, who represented 90% of the roughly 41 000 practitioners in activity in 2011. The remaining 10% were salaried staff within specialized dental care centres, often managed by mutual VHI entities, or in hospitals. National strategies to improve dental care have focused on children and adolescents. The government set an objective in the 2004 Public Health Act to reduce the tooth decay index by 30% among children aged 6 to 12 within five years. While this objective was met, dental problems remain frequent, particularly among children from low-income families or without good access to care. Since 2007, a free oral care examination programme called M’T Dents, has been offered to children aged 6, 9, 12, 15 and 18, with follow-up care (other than prosthetics, orthodontics or dental appliances) fully covered by SHI. In addition, hour-long oral health prevention sessions are provided to all children in primary school. While the HAS recommends an annual dental check-up for children and adults, a nationwide survey found that 30% of children aged 5 to 15 had not had a check-up within the preceding 12 months. Moreover, significant disparities were evident depending on the family’s socioeconomic status. Unfamiliarity with the free programme, as well as fear of dental visits, may explain the differences in recourse to care (Calvet et al., 2013). In 2012, dental care represented 5.72% of personal health care consumption but only 2.39% of SHI expenditure because of extra-billing, which accounted for 53% of dental care fees, primarily for dental prosthetics and orthodontics. Unlike doctors, all dentists may engage in extra-billing, but not for all services. Extra-billing for conservative dentistry (tartar removal, fillings, root canals) is prohibited. While VHI covers the largest share of dental care expenditure, a substantial part is financed by OOP payments, giving rise to inequalities in access. A survey of patients’ failure to seek treatment found that 47% of the forgone treatments were for dental care (Célant, Guillaume & Rochereau, 2014). Access to dental care also varies by region. There are 63 dentists per 100 000 inhabitants on average, with wide variations in their geographic distribution: half work in areas with more than 200 000 inhabitants, while only 6% practice in rural zones.
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Contents Contents Preface
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Preface Preface The Health Systems
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Abstract Abstract This analysis of
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1. Introduction 1. Introduction The
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