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38 Health systems in transition France 2.5.4 Cross-border mobility of patients and health workers France has entered into trans-border agreements for the use of hospital facilities in the border regions of Belgium, Italy, Spain and Switzerland. France and Belgium, which have the most extensive cross-border patient movements, have implemented common protocols for emergency care as well as an agreement established by four hospitals in neighbouring cities that allows patients from both countries to receive care without preliminary authorization from either health system. Wider patient mobility throughout the EU, the EEA and the rest of the world is governed by European regulations and international agreements (see section 2.9.6). In terms of mobility of health workers, France is a net receiving country, as emigration of French-trained professionals is low. French law distinguishes professionals with European diplomas, who are entitled to the same rights as French-trained professionals pursuant to European regulations, and those with diplomas from outside the EU, who are subject to stricter standards. Doctors with non-EU diplomas may be authorized to practise on a case-by-case basis, while paramedical professionals trained outside of the EU must resume their studies and obtain a French diploma (see section 4.2.2). 2.5.5 Health sector preparedness Responsibility for the government’s response to exceptional health emergencies (situations sanitaires exceptionnelles) falls largely under the Minister of the Interior and the Ministry in charge of Health within the context of an interministerial crisis unit (cellule interministérielle de crise). Four national agencies have key roles: InVS, ANSM, ANSES and EPRUS (see section 2.3.4). EPRUS, in particular, has a transverse role, falling under the shared oversight of the General Directorate of Health and Health Emergencies Department (Département des Urgences Sanitaires), with a director selected from the prefectural corps attached to the Interior Ministry. EPRUS provides logistic expertise and support in terms of materials, training and personnel, including 6000 voluntary reservists, mostly doctors and nurses. At the regional level, health crisis preparation is undertaken pursuant to the organization plan for the health system response to public health emergencies (Organisation de la réponse du système de santé en situations sanitaires exceptionnelles), which defines appropriate care pathways for various emergency situations as well as coordination modalities among the actors, including assignment and management of response measures and the training
Health systems in transition France 39 of health professionals to respond to such emergencies. The ARSs must develop an organization plan, which is implemented under the control of the prefect in the event of a crisis. 2.6 Intersectorality The National Public Health Committee (Comité national de santé publique) is the steering committee for broad intersectoral health plans. Created by the 2004 Public Health Act, it was designed to improve coordination and information exchange among the ministries whose policies may have a health impact, particularly in the areas of health security and prevention. The Committee comprises directors or representatives from the ministries in charge of health, social security, social affairs, labour, education, security, defence, justice, finance, agriculture and environment, as well as UNCAM, the Directorate of Research, Studies, Evaluation and Statistics (Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques) and the interministerial missions regarding drugs and addictions, cities and road safety. While this is an intersectoral approach, to date the Committee has undertaken few operational activities. Nonetheless, there are specific areas in which intersectoral cooperation is better defined and developed, as it is the case, for example, with health emergency preparedness (see section 2.5.5) and with policy against drug addiction, which is the oldest and more developed intersectoral action based on the Health in All policy approach. Ten ministries are part of the Interministerial Mission for the Fight against Drugs and Addictive Behaviours (Mission interministèrielle de lute contre les drogues et les conduites addictives). The interministerial mission was created in 1982 with the objectives of coordinating public policies on this matter but also providing funding and help in designing appropriate policies (MILDECA, 2015). It works with the help of the OFDT and the interministerial centre for anti-drug training (Le centre interministériel de formation anti-drogue), which focuses on the fight against cocaine. Moreover, the Interministerial Committee to Combat Exclusion (Comité interministériel de lutte contre l’exclusion) currently takes actions that aim to reduce health inequalities within a multiyear plan against poverty and social inclusion, which was adopted in December 2012. Key initiatives include reducing financial barriers to access to care, for example by making more user-friendly access to programmes providing CMU-C (see section 3.5.1);
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Contents Contents Preface
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Preface Preface The Health Systems
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Acknowledgements Acknowledgements T
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7. Assessment of the health system
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