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Assessment of the French health system and analysis of the reforms of 2004

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This document presents the stakes involved to reform the present health care system in order to ensure its future by preserving the principles which are attached to it. These principles include equal access to care facilities, the quality of the care and solidarity. The government also proposed a reform of health insurance materialized by the law of August 13, 2004. It is based on the proposals of the High Council for facilitating the future of health insurance (HCAAM). This is seen as a measure to assess the system of health insurance, and presents three axes to ensure the viability of the modes of health insurance and social cohesion. The government estimates that it is necessary to improve the organization and operation of the system of care, as well as the level of the general piloting of the recourse of healthcare.

With regard to the members of the National Insurance Scheme, it is necessary to make choices based on scientific criteria without calling into question the universality of the cover. Additionally, it is essential to operate a financial recovery of the health insurance by the installation of more efficient organizations of care. Today, it is hard to say if the Douste-Blazy reform, which came into effect on January 1, 2005, is a failure or a success since the results are not yet really perceptible.

However certain elements prove that this reform was criticized on certain points and thus, seems to bear its fruits. To draw up the assessment of the French health system and to analyze the reforms of 2004, the document will be based on three parts: first of all, we will see the characteristics of the French health system before the reform, then we will analyze the contents of the reform of 2004 and finally we will present some aspects of the same, after having shown the difficulty of deducing some from the results.

The spread of health insurance for the entire population and distribution of additional coverages allow virtually all French citizens to be insured, regardless of health, age or income, to have easy access to care, with a good level of support.

Compulsory schemes reimburse 76% of total health expenditure, which means they reach, if we take for reference the goods and services that are part of "recognized" care by the health insurance, a rate of 81%. This level of care results from the combination of reimbursement rates (which range, for most goods and services, between 65 and 80%) and a very powerful system of exemptions resulting in a refund almost complete as soon as the expenses are high. Most households take on a co-payment that may eventually be exonerated or paid by a mutual or complementary insurance. The amount of co-payments for their "routine" care is relatively low. For example, for a consultation with a general practitioner, the Health Insurance fund pays 14 euros. The amount of co-payments still to charge is 6 euros.

Tags : French healthcare system, health insurance, HCAAM

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