French government seizes purse strings

BMJ 1996; 312 doi: (Published 04 May 1996) Cite this as: BMJ 1996;312:1119
  1. Alexander Dorozynski

    Despite strikes and demonstrations by doctors the French National Assembly last week adopted a bill that will give the government control over health spending. The bill—still to be approved by the Senate—gives parliament the authority to determine the ceiling of health costs from year to year.

    It provides for penalties against doctors who prescribe in excess of medical guidelines and paves the way for medical networks, through which general practitioners will channel their patients to specialists, thus preventing the expense of patients consulting several doctors for the same ailment.

    The medical profession is still divided on the reforms proposed by prime minister Alain Juppe. Three medical unions protested, calling for demonstrations and the closing of medical offices. But the major general practitioners' union, MG France, favoured the reforms, chiefly aimed at controlling escalating health costs.

    Thousands of French doctors closed their offices for the day on 25 April, and in large cities such as Paris, Marseille, Bordeaux, and Strasbourg hundreds took to the streets. According to the Union Nationale des Generalistes de France, another union of general practitioners, two thirds of France's medical offices were closed on 25 April.

    The overwhelmingly right wing National Assembly adopted the new bill in the face of opposition from socialist and communist deputies, who warned that it could be a first step towards the privatisation and rationing of health care.

    The three medical unions that opposed the bill issued their members with instructions to retaliate: from 1 May doctors should not supply authorisations to stay away from work for medical reasons—only certificates that would need prior approval by the social security administration; and they should not fill in slips authorising the reimbursement of prescribed drugs—only prescriptions.—ALEXANDER DOROZYNSKI, medical journalist, Paris

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