France faces radical health insurance reforms

BMJ 1995; 311 doi: (Published 25 November 1995) Cite this as: BMJ 1995;311:1386
  1. ALEXANDER DOROZYNSKI, medical journalist
  1. Paris

    The French prime minister, Alain Juppe, received overwhelming support from the National Assembly last week for his plan for a thorough reform of the 50 year old social security system. Deputies voted 463 to 87 to back his project to eliminate the Fr250bn (pounds sterling32bn) debt through a special tax on all incomes, to empower parliament to impose ceilings on welfare spending, and to streamline health administration.

    Later in the week the Senate passed a vote of confidence in Mr Juppe, who said that the most urgent measures would be carried through in the coming months.

    Apart from opposition by doctors, protest against the proposed reform has been weaker than expected. Even some socialist opponents acknowledged the boldness of the plan, which is the first real reform after more than 20 attempts to patch up the problems.

    Nevertheless, the seven unions representing civil servants were planning to strike on 24 November, and medical unions are expected to protest against the “rationing of health care” and loss of income. The health insurance branch of the social security organisation, which has a debt of Fr250bn was the main target of reforms.

    One of the key measures in the reforms is the introduction of an extra 0.5% tax on income, including savings and social benefits. In addition, an annual budget will be voted in for the social security's health insurance branch; this will impose a check on the fund's administration, which until now has been largely controlled by employers and trade unions.

    Continuing medical education will be compulsory, and the use of medical guidelines that outline standard practices for major diseases will be extended. Doctors will have to contribute Fr1 (13p) per prescription to a fund to cover nationwide computerisation to reduce the administration costs of health insurance. It is estimated that Mr Juppe's new measures will cost up to Fr 13600 (pounds sterling1700) a year to an average general practitioner with an income of Fr 360000 (pounds sterling45000).

    Regional agencies will allocate hospital budgets authorised by the government to private and public hospitals after an evaluation of need and the quality and cost of services. The number of hospital beds will be gradually reduced.

    Patients will be encouraged to consult a general practitioner rather than a specialist Alain Juppe hopes that the social security system will balance its budget by 1997. Politicians in the past have let the deficits go adrift, he said: “The government wants a reform that is made to last.


    Alain Juppe: trying to build something that will last

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