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194 Health systems in transition France 7.6 Transparency and accountability The transparency of the health system was called into question in the wake of the Mediator scandal and resulted in major changes to the regulatory agency for health products (now ANSM), including disclosure of direct and indirect interests by health professionals providing expert advice within the decisionmaking process (see section 6.1.1). Since 2014, a searchable public database (www.transparence.sante.gouv.fr) identifies health professionals’ relationships with companies marketing drugs and other health products. Nonetheless, accountability has improved in recent years through monitoring of spending and public health objectives under the Social Security Financing Laws, as well as through the development of information systems.
8. Conclusions 8. Conclusions In France, the overall health status of the population is good as well as the degree of financial protection provided by the health system. Women live longer and older people remain in better health than in many European countries. Patients in France are three times less likely to report forgoing care because of long waits than the EU average. Public financing of health care expenditure is among the highest in Europe and OOP spending one of the lowest. Nonetheless, major problems include social and geographical inequalities in health status and access to care; a relative underdevelopment of preventive care compared with acute care; and a lack of coordination between the hospital sector, the ambulatory care sectors and the health and social care sectors, in particular in caring for patients with chronic diseases but also in developing preventive care and intersectoral policies. Social inequalities remain in terms of health status and access to care. Life expectancy at age 35 is seven years lower for working class men and three years lower for working class women compared with managers. These social health inequalities result not only from risk factors such as alcohol and tobacco consumption but also from differences in access to health care, which have increased over time. Indeed income-related inequalities in health care utilization remain despite universal coverage and relatively low OOP payments. This inequity in access is predominant in goods and services for which patients’ OOP expenditure is the highest, such as dental care and consultations with specialists engaging in extra-billing. Geographical disparities in the density of health professionals also affect access to care in some areas of France. While the average physician density should provide adequate nationwide coverage, certain areas are underserved.
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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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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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France

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