World Report
French health workers strike over payment plan in health bill
Opposition from health professionals is threatening to derail government plans to introduce third-party payments for all in a bill to go before parliament in the next few weeks. The bill, the first step in implementing the socialist government’s national health strategy that was unveiled in September, 2013, is aimed at streamlining French health care and reducing the cost to help rein in the country’s huge public deficits. It is the most far-reaching reform for the medical sector since the 2004 Health Insurance Act, but the extension of third-party payments by 2017 is far from the most substantial change, says Valérie Paris, senior health policy analyst at the Organisation for Economic Cooperation and Development in Paris. Many other points in the law are more important, she says. They include improvements in the regional organisation and planning of health services to ensure coordination between the national health insurance agency and other agencies, which have often been criticised for not being on the same page. But the payment question is the one that has angered general and other health-care practitioners the most, bringing them out on strike sporadically since the end of December and culminating in a major demonstration planned for March 15. They fear they will be besieged by patients, reimbursements will be delayed, and bureaucracy will be too heavy. Some also reject the idea of becoming quasicivil servants. The issue has now been taken up by socialist President François Hollande, who has promised that third-party payments will be introduced only if a simple mechanism is found for health professionals. Marisol Touraine, Social Affairs, Health and Women’s www.thelancet.com Vol 385 March 7, 2015
Rights Minister, is helping to address the question in one of four working parties set up in January to iron out the wrinkles on several key points in the bill. But time is short, and if Touraine fails to find a compromise in time, she might lose her job in the next government reshuffle, suggests the French newsweekly L’Obs. When she presented the bill to the cabinet, Touraine described the French health-care system as “illegible and complex”, and noted that patients pointed in the wrong direction often found themselves “in great difficulty”.
“Health care is one of the hardest sectors to reform in France, since it is nearly a religion for the French people’...” To help remedy the problem, the bill calls for a single national telephone number to give patients immediate access to a doctor on call any time, anywhere. It aims to boost preventive medicine, particularly for the young, and to break down barriers between the different professions by filling the gap between those with 3 years of higher education and those with 12 years. It tackles the lack of ambulatory care in the rural areas shunned by general and specialist practitioners, tries to alleviate drug shortages, and increases patients’ rights to information. It also strengthens patients’ associations by extending to health the law allowing class action suits in France that was passed last year after many years of hesitation. Health and other social security spending is a key element in France’s efforts to reduce its public deficits under pressure from the European Commission in Brussels, and is supposed to contribute €10 billion of the €50 billion in savings slated for
2015–17. Progress is already being achieved on the health score, says neurologist Olivier Véran, a socialist member of parliament and rapporteur for health bills. Annual targets have been set by parliament for reducing the social security deficits since 1996, and were met for the first time in 2010. Since 2012, the government has lowered public health-care spending increases to about 2% a year from more than 3%, says Véran. Even so, the deficit this year is expected to end the year at €10·5 billion compared with €7·3 billion in 2014. In its annual report for 2014, released in February, the French audit authority—Cour des Comptes— criticised the government for failing to provide equal palliative care across the country as intended. The gap will not be filled in the law, but in a separate 3-year plan that Touraine says will be drawn up this year. Of the three plans launched in 2008—cancer, Alzheimer’s, and palliative care—the last has been the least successful, Antoine Durrleman, the authority’s senior expert on health issues, told The Lancet. It is uncertain how much of the latest health bill will survive the parliamentary vote before becoming law later this year, and how much difference it will make anyway. “The bill is promising, and I hope more of it will be implemented than was the case with the 100 objectives in the public health law that was passed in 2004”, says Paris. But it was never expected to be painless. Health care is one of the hardest sectors to reform in France, since it is nearly a religion for the French people, adds Véran.
Jeff Pachoud/Staff
Health professionals in France have been sporadically striking over a proposal to reform the payments system in the government’s new health bill. Barbara Casassus reports from Paris.
For more on France’s national health strategy see Lancet 2014; 383: 9923
Barbara Casassus e18
French health workers strike over payment plan in health bill
Opposition from health professionals is threatening to derail government plans to introduce third-party payments for all in a bill to go before parliament in the next few weeks. The bill, the first step in implementing the socialist government’s national health strategy that was unveiled in September, 2013, is aimed at streamlining French health care and reducing the cost to help rein in the country’s huge public deficits. It is the most far-reaching reform for the medical sector since the 2004 Health Insurance Act, but the extension of third-party payments by 2017 is far from the most substantial change, says Valérie Paris, senior health policy analyst at the Organisation for Economic Cooperation and Development in Paris. Many other points in the law are more important, she says. They include improvements in the regional organisation and planning of health services to ensure coordination between the national health insurance agency and other agencies, which have often been criticised for not being on the same page. But the payment question is the one that has angered general and other health-care practitioners the most, bringing them out on strike sporadically since the end of December and culminating in a major demonstration planned for March 15. They fear they will be besieged by patients, reimbursements will be delayed, and bureaucracy will be too heavy. Some also reject the idea of becoming quasicivil servants. The issue has now been taken up by socialist President François Hollande, who has promised that third-party payments will be introduced only if a simple mechanism is found for health professionals. Marisol Touraine, Social Affairs, Health and Women’s www.thelancet.com Vol 385 March 7, 2015
Rights Minister, is helping to address the question in one of four working parties set up in January to iron out the wrinkles on several key points in the bill. But time is short, and if Touraine fails to find a compromise in time, she might lose her job in the next government reshuffle, suggests the French newsweekly L’Obs. When she presented the bill to the cabinet, Touraine described the French health-care system as “illegible and complex”, and noted that patients pointed in the wrong direction often found themselves “in great difficulty”.
“Health care is one of the hardest sectors to reform in France, since it is nearly a religion for the French people’...” To help remedy the problem, the bill calls for a single national telephone number to give patients immediate access to a doctor on call any time, anywhere. It aims to boost preventive medicine, particularly for the young, and to break down barriers between the different professions by filling the gap between those with 3 years of higher education and those with 12 years. It tackles the lack of ambulatory care in the rural areas shunned by general and specialist practitioners, tries to alleviate drug shortages, and increases patients’ rights to information. It also strengthens patients’ associations by extending to health the law allowing class action suits in France that was passed last year after many years of hesitation. Health and other social security spending is a key element in France’s efforts to reduce its public deficits under pressure from the European Commission in Brussels, and is supposed to contribute €10 billion of the €50 billion in savings slated for
2015–17. Progress is already being achieved on the health score, says neurologist Olivier Véran, a socialist member of parliament and rapporteur for health bills. Annual targets have been set by parliament for reducing the social security deficits since 1996, and were met for the first time in 2010. Since 2012, the government has lowered public health-care spending increases to about 2% a year from more than 3%, says Véran. Even so, the deficit this year is expected to end the year at €10·5 billion compared with €7·3 billion in 2014. In its annual report for 2014, released in February, the French audit authority—Cour des Comptes— criticised the government for failing to provide equal palliative care across the country as intended. The gap will not be filled in the law, but in a separate 3-year plan that Touraine says will be drawn up this year. Of the three plans launched in 2008—cancer, Alzheimer’s, and palliative care—the last has been the least successful, Antoine Durrleman, the authority’s senior expert on health issues, told The Lancet. It is uncertain how much of the latest health bill will survive the parliamentary vote before becoming law later this year, and how much difference it will make anyway. “The bill is promising, and I hope more of it will be implemented than was the case with the 100 objectives in the public health law that was passed in 2004”, says Paris. But it was never expected to be painless. Health care is one of the hardest sectors to reform in France, since it is nearly a religion for the French people, adds Véran.
Jeff Pachoud/Staff
Health professionals in France have been sporadically striking over a proposal to reform the payments system in the government’s new health bill. Barbara Casassus reports from Paris.
For more on France’s national health strategy see Lancet 2014; 383: 9923
Barbara Casassus e18
