France

xxiv
Health systems in transition
France
Provision of services
Public health responsibilities are divided between many actors at the national
and local level. At national level, the key bodies are the French Institute for
Public Health Surveillance (Institut National de Veille Sanitaire; InVS) and
the National Institute for Prevention and Health Education (Institut national de
prévention et d’éducation pour la santé; INPES), which is involved in managing
health crises and informing the population.
Primary and secondary health ambulatory care is provided by self-employed
doctors, dentists and medical auxiliaries (including nurses and physiotherapists)
working in their own practices, and, to a lesser extent, by salaried staff in
hospitals and health centres. From the late 1990s, GPs have taken on a major
role in the coordination of care through a semi-gatekeeping system that provides
incentives to people to visit their GP prior to consulting a specialist.
France is the third largest European producer of pharmaceutical products;
the French population is also among the largest consumers of pharmaceutical
drugs, consuming 22% more than neighbouring countries. Drugs are dispensed
by self-employed pharmacists, while the price of drugs is set administratively
for all drugs covered by SHI.
Acute medical care is mainly provided by public hospitals, which account for
nearly two-thirds of acute medical care capacity (67% of medical beds and 50%
of day-care beds) and are responsible for 65% of full-time episodes and 42% of
day-care episodes. Private profit-making hospitals tend to specialize in a small
number of technical procedures for which there are profit opportunities, such as
invasive diagnostic procedures (e.g. endoscopy or coronary angiography), and
surgical procedures that can be performed routinely within a short stay with a
predictable length. Public hospitals perform a much wider range of surgeries
than profit-making hospitals, including the most complex procedures.
As in many other European countries, mental health care policy in France
during the second half of the 20th century was influenced by a general
movement towards community-based organization of mental health care
services – the so-called “deinstitutionalization” process. The vast majority of
care in the psychiatric sector is ambulatory, with 77% of patients over the
course of a year treated exclusively on an outpatient basis.