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2 Health systems in transition France 1.1 Geography and sociodemography The French Republic comprises metropolitan France, located in western Europe (the mainland plus Corsica), and a collection of overseas islands and territories on other continents. The five overseas departments (French Guyana, Guadeloupe, Martinique, Mayotte and Réunion) are an integral part of the French Republic and subject to the same laws and regulations, although local adjustments are possible. The other overseas territories (French Polynesia, Saint Barthélemy, Saint Martin, Saint Pierre and Miquelon, Wallis and Futuna, New Caledonia and the French Southern and Antarctic Lands) are also part of France but have differing legal status. Metropolitan France is bordered from north to east and south by Belgium, Luxembourg, Germany, Switzerland, Italy, Monaco, Andorra and Spain (Fig. 1.1). Its geography is varied, from coastal plains in the north and west to mountain ranges in the south-west (the Pyrenees) and the south-east (the Alps), including Mont Blanc, the highest point in western Europe at 4810 m (15781 ft). The climate is temperate. Fig. 1.1 Map of France United Kingdom Neth. Dunkerque Bel. Lille Cherbourg Le Havre Lux. Rouen Strasbourg PARIS Brest Nancy Orléans Tours Dijon Nantes Switz. Germany Bay of Biscay Spain 0 100 200km 0 100 200ml Lyon Saint-Étienne Grenoble Bordeaux Nice Montpellier Toulouse Marseille And. Corsica Italy Source: CIA, 2009.
Health systems in transition France 3 On 1 January 2013, the French population totalled 63.7 million inhabitants in metropolitan France and 2.1 million inhabitants in the five overseas departments (INSEE, 2013a). It is the second most populous country in the EU after Germany. Table 1.1 shows the most recent demographic indicators. Table 1.1 Trends in demographic and socioeconomic indicators for metropolitan France, 1980–2014 (selected years) 1980 1990 1995 2000 2005 2010 2014 Total population (millions) 53.7 56.5 57.7 58.8 60.9 62.7 66.2 Population, female (% of total) 51.2 51.3 51.4 51.5 51.6 51.6 51.0 Population aged 0–19 years (% of total) 30.6 27.8 26.1 25.6 25.0 24.5 24.4 a Population aged ≥ 60 years (% of total) 17.0 19.0 20.0 20.6 20.9 22.8 24.0 a Population aged ≥ 75 years (% of total) 5.7 6.8 6.1 7.2 8.1 8.9 9.2 a Population growth (average annual growth rate) 0.4 0.5 0.4 0.7 0.8 0.5 0.5 b Population density (average per km 2 ) 100.83 106.65 108.72 111.22 115.36 118.74 121.00 Fertility rate, total (births per woman) 1.9 1.8 1.7 1.9 1.9 2.0 1.9 a Birth rate, crude (per 1,000 people) 14.9 13.4 12.6 13.1 12.7 12.8 12.2 a Death rate, crude (per 1,000 people) 10.2 9.3 9.2 9.0 8.6 8.6 8.8 a Age dependency ratio (% of working population) 57.0 51.0 54.0 54.0 54.0 54.0 59.0 Percentage population urban 73.3 74.1 74.9 76.9 81.5 85.2 79.0 Proportion of single-person households 24.6 27.1 na 31 32.8 33.6 c na School enrolment, tertiary (% gross tertiary enrolment) 25.0 37.0 50.0 54.0 55.0 57.0 60.0 Sources: INSEE, 2013a; World Bank, 2015. Notes: a 2013 data; b 2012 data; c 2009 data; na: Not available. Metropolitan France covers an area of about 552 000 km 2 , and with an average population density of 119/km 2 it ranks 12th in the EU. However, average density conceals considerable variations; half of the population lives in just over 10% of this territory, while large areas remain sparsely populated. By 2012, 86% of the population lived in urban areas, with the greatest growth in outer suburbs and rural areas surrounding towns, rather than in the city centres. Nonetheless, the population of rural areas has grown 1.5 times faster than urban areas over the past ten years (Brutel & Levy, 2012). Historically, French immigration policy has been characterized by a tradition of welcome, assimilation and integration of foreigners. However, recent laws have imposed stricter conditions for family reunification and asylum. In 2008, an estimated 5.3 million immigrants (born in a foreign country) resided in France, representing 8.3% of the population (INSEE, 2012b). Individuals born in Algeria, Morocco and Tunisia accounted for 30% of France’s immigrant population.
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Page 5 and 6: Contents Contents Preface
Page 7 and 8: Preface Preface The Health Systems
Page 9 and 10: Acknowledgements Acknowledgements T
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Page 19: Abstract Abstract This analysis of
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Page 31: 1. Introduction 1. Introduction The
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3. Financing 3. Financing Health ca
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4. Physical and human resources 4.
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6. Principal health care reforms 6.
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7. Assessment of the health system
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8. Conclusions 8. Conclusions In Fr
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