France

30
Health systems in transition
France
Smaller schemes cover just over two million people, also on an employmentrelated
basis. Several are linked to the general scheme, including those for
local and national civil servants, doctors working under state health agreements,
students and military personnel. Other schemes, such as those for miners,
employees of the national railway company, the clergy, seamen and the
national bank, function autonomously. For historical reasons, people from the
Alsace and Moselle regions benefit from their own scheme, which offers better
coverage with higher contribution rates.
2.3.6 Professional organizations
There are two types of professional organizations: professional associations or
chambers (conseil de l’ordre) and trade unions. For most medical specialties,
both an association and a union exist. Professional associations or chambers
for doctors, pharmacists, dentists, midwives, physiotherapists and nurses are
concerned with medical ethics and the supervision of professional practice. The
association is responsible for all matters pertaining to the scientific activities
of a specialty, including developing guidelines and ensuring compliance with
annual DPC requirements, while the union is in charge of the negotiations
between the professionals and SHI over fees and other matters affecting practice.
In addition to their professional organizations and unions, health professionals
may also join any of the trade unions that exist to represent workers in all fields
of industry and services.
Trade union representation is fragmented, not only because of the existence
of different professions but also through differences in status, for example,
between salaried and self-employed professionals. In addition to “vertical”
unions, which represent interests at the national level, “horizontal” unions have
developed at the departmental level. There are five unions for self-employed
doctors that are considered representative and competent to sign fee agreements
with SHI. Because of this diversity, the unions’ positions on government
measures may differ. Only 15–20% of physicians in private practice are union
members (Borgetto, 2008).
At the national level, an umbrella organization represents all health care
professionals in private practice, the National Union of Health Professionals
(Union Nationale des Professions de Santé). It sets the agenda for negotiations
between health professionals and SHI and VHI (see section 3.3.4). Similarly, at
regional level, regional unions of health professionals (Unions Régionale des
Professionnels de Santé) negotiate with the ARSs (see section 2.4).