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20 Health systems in transition France The outcome of these negotiations is translated into administrative decrees and laws passed by the parliament and collective agreements signed by SHI and health professionals’ representatives. These include the Public Health Act (Loi relative à la politique de santé publique), Social Security Finance Act (Loi de financement de la sécurité sociale) and other reform acts. In the context of increasing health care expenditure and the increasing deficit of SHI, the role of the state in planning and regulation has increased since the mid-1990s. Responsibility for capacity planning is shared by the central and the regional levels. At the regional level, the ARSs coordinate ambulatory and hospital care for the population as well as health and social care for the elderly and the disabled through the PSRS, which is based on population needs. Each sector’s planning process must comply with the PSRS. This is a first attempt at regional planning of the ambulatory care sector. Providers are paid by SHI, but patients may have to pay the provider and claim reimbursement by SHI afterwards (e.g. for GP visits). The statutory tariffs are set through negotiations between providers and SHI and are approved by the Ministry in charge of Health. Quality of care is regulated at the national level. Hospitals must undergo a certification process every four years but there is no formal recertification or relicensing process for health professionals. However, doctors, pharmacists, dentists and midwives are required to follow lifelong learning activities through professional continuous development. 2.1 Overview of the health system The French health care system is structurally based on a Bismarckian approach, with goals of universality and solidarity that have led to an increasingly Beveridge style of system. SHI currently covers almost 100% of the resident population. Jurisdiction over health policy and regulation of the health care system (Fig. 2.1) is divided among: • the state: the parliament and the government, specifically the Ministry in charge of Health; • SHI; and • local communities to a lesser extent, particularly at the regional level.
Health systems in transition France 21 Fig. 2.1 Overview of the health system in France, 2014 National level Parliament Alert Committee Government/ Ministry in charge of Health High Council for the Future of Health Insurance SHI (National Union of Insurance Funds) High Level Council of Public Health National Health Authority National Health Conference National Council for the Governance of Regional Health Agencies (SHI, Ministry in charge of Health, National Solidarity Fund for Autonomy) Self-employed health professionals Regional level Regional Conference on Health and Autonomy Regional health agency Regional Union of Health Professionals Two coordination commissions: prevention and disability (local subsidiaries of the state, general council, local SHI funds) Planning Planning Planning Hospital sector services Health and social care sector for elderly and disabled Ambulatory care sector services Hierarchical Advisor Negotiation
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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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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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