Intended for healthcare professionals


France seeks to curb health costs by fining doctors

BMJ 1997; 315 doi: (Published 11 October 1997) Cite this as: BMJ 1997;315:895

Heavy handed and expensive

  1. Jennifer Dixon, Fellow in policy analysisa
  1. a King's Fund Policy Institute, London W1M 0AN

    In happier times of economic growth, most Western governments had a light touch in controlling health care costs. But as the growth of health care spending has outstripped the performance of most economies since the 1970s, health care payers have realised the need to act more firmly. They face powerful groups with an interest in resistance: health care providers, who gain from increased income.

    Fortunately some tools are available to help targeting costs at health care, doctors, and patient level. At the “system” level the most effective is a limit on overall annual expenditure. Britain is a good example of this: health care spending has grown less than in almost all other Western countries since the 1970s. But while this method controls overall costs, it does little to relieve pressures on the budget. Other tools are needed, such as controlling the number of doctors; paying providers capitation fees rather than fees for service; and having primary care providers acting as gatekeepers to secondary care.

    At a more micro-level are …

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