France

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Health systems in transition
France
The National Health Conference brings together representatives of the
health professions, health care facilities, the Regional Conference on Health
and Autonomy (Conférence régionale de la santé et de l’autonomie; CRSA)
and other experts, to discuss and define health care priorities at the national
level. The strategy is mainly implemented through the regional health projects
(projets régionaux de santé; PRS), through which the PSRS is developed by
the ARSs in consultation with the stakeholders who participate in the CRSAs
on health and autonomy (see section 2.4).
The HCSP is composed of numerous independent public health experts
and volunteers appointed by the minister intuitu personae and a share of
representatives of various subordinate health agencies. It provides guidance
regarding public health problems and issues related to the organization of
health care. It undertakes regular overviews of the population’s health status,
prepares general analyses and forecasts of public health problems, contributes
to the definition of public health objectives (objectifs de santé publique) and
makes proposals for strengthening preventive measures. It can also be consulted
on specific questions concerning the organization of treatment, and in that
context, it can set up working groups to produce reports on issues and formulate
proposals. It also monitors the health target objectives of the Public Health Act
and suggests new objectives.
2.4 Decentralization and centralization
Regional level
The general philosophy underlying decentralization in France reflects a marked
reluctance to reduce central control over policy and finance, and as a result, it
has mainly come in the form of deconcentration. The creation of the ARSs in
2010 changed the regional landscape by merging seven regional institutions (see
section 2.4 in Chevreul et al., 2010) into a single regional entity traversing the
traditional boundaries of health care, public health and health and social care
for elderly and disabled people.
The 26 ARSs are responsible for ensuring that the provision of health care
services meets the needs of the population by improving the coordination
between the ambulatory and hospital sectors and health and social care sector
services, while respecting the ONDAM (see section 3.3.3). They are also
responsible for implementing regional health policy in relation to occupational
health services, mother and child health protection services (protection
maternelle et infantile; PMI), and university and school health services.