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French Health System Reform: Implementation and Future Challenges

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Eurohealth RESEARCH • DEBATE • POLICY • NEWS Volume 12 Number 3, 2006 French health system reform: Implementation and future challenges Interview with Xavier Bertrand, French Minister of Health Pharmaceutical and human resource policies in France Hospital reform: a new era of public/private competition? Germany: Is Bismarck going Beveridge? • Climate change and health • Sexually transmitted infections Obesity control • Mental health reform in Romania • Stem cell politics • Choice and deregulation in Sweden Eurohealth Plus ça change……? LSE Health, London School of Economics and Political Plus ça change, plus c’est la meme chose – the more Science, Houghton Street, London things change, the more they stay the same! All too WC2A 2AE, United Kingdom C fax: +44 (0)20 7955 6090 often this can be said of health care reform. It is apt email: [email protected] therefore, that much of this issue of Eurohealth is www.lse.ac.uk/LSEHealth devoted to the French health system. Zeynep Or, Editorial Team Chantal Cases and colleagues at the Institute for EDITOR: Research and Information on Health Economics David McDaid: +44 (0)20 7955 6381 O (IRDES) in Paris have brought together contributions email: [email protected] describing and reflecting on the consequences of major FOUNDING EDITOR: Elias Mossialos: +44 (0)20 7955 7564 reforms enacted in 2004. We are especially delighted to email: [email protected] feature an interview with Xavier Bertrand, French DEPUTY EDITOR: Minister of Health. Sherry Merkur: +44 (0)20 7955 6194 M email: [email protected] Previously ranked by WHO as the best performer, the EDITORIAL BOARD: Reinhard Busse, Josep Figueras, Walter Holland, French health system is not without problems. It has Julian Le Grand, Martin McKee, Elias Mossialos traditionally operated with little regard to efficiency or SENIOR EDITORIAL ADVISER: cost containment. It has the highest rate of pharma- Paul Belcher: +44 (0)7970 098 940 ceutical use in the EU, while, until recently at least, there email: [email protected] M DESIGN EDITOR: has been little attempt to incorporate cost effectiveness Sarah Moncrieff: +44 (0)20 7834 3444 into policy making. The health workforce is ageing; email: [email protected] geographical inequalities in access to services exist. SUBSCRIPTIONS MANAGER Moreover, promotion and prevention have not been Champa Heidbrink: +44 (0)20 7955 6840 email: [email protected] high priorities. E Advisory Board The 2004 reforms make use of economic incentives to Anders Anell; Rita Baeten; Nick Boyd; Johan Calltorp; Antonio Correia de Campos; Mia Defever; Nick Fahy; influence the behaviour of health professionals and the Giovanni Fattore; Armin Fidler; Unto Häkkinen; Maria public. These include a system of gate keeping for Höfmarcher; David Hunter; Egon Jonsson; Meri Koivusalo; Allan Krasnik; John Lavis; Kevin McCarthy; Nata primary care, activity-based payments and managerial Menabde; Bernard Merkel; Stipe Oreskovic; Josef Probst; freedom in hospitals, incentives to use generic drugs, Tessa Richards; Richard Saltman; Igor Sheiman; Aris N Sissouras; Hans Stein; Jeffrey L Sturchio; Ken Thorpe; support for general practice training and investment in Miriam Wiley public health campaigns. Article Submission Guidelines Will the reforms lead to sustainable change? Will the see: www.lse.ac.uk/collections/LSEHealth/documents/ eurohealth.htm French experience be of relevance elsewhere in Europe? In truth, it is too early to say, but the initial signs are Published by LSE Health and the European Observatory T on Health Systems and Policies, with the financial support encouraging. According to M. Bertrand, for the first of Merck & Co and the European Observatory on Health time in ten years the Statutory Health Insurance has Systems and Policies. stayed within expenditure limits. The potential to realise Eurohealth is a quarterly publication that provides a forum for researchers, experts and policymakers to express their greater savings while still investing in high quality views on health policy issues and so contribute to a innovative therapies remains strong. It is to be hoped in constructive debate on health policy in Europe. a few years, when speaking of the reforms we might be The views expressed in Eurohealth are those of the authors alone and not necessarily those of LSE Health, Merck & Co able to say plus ça change, plus c’est la difference! or the European Observatory on Health Systems and Poli- cies. David McDaid Editor The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Sherry Merkur Deputy Editor Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Lux- embourg, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. © LSE Health 2006. No part of this publication may be copied, reproduced, stored in a retrieval system or transmitted in any form without prior permission from LSE Health . Design and Production: Westminster European email: [email protected] Printing: Optichrome Ltd ISSN 1356-1030 Contents Eurohealth Volume 12 Number 3 Eurohealth Debate Michael W Adler is Professor Emeritus of Genitourinary Medicine, Centre for Sexual 1 Can adaptation reduce the health effects from Health & HIV Research, Royal Free & climate change? University College Medical School, University Robert Mendelsohn College London, UK. Yvon Berland is Professor of Medicine and President of the French National Observatory Public Health Perspectives of Health Professions. 3 Sexually transmitted infections in Europe Xavier Bertrand is the Minister of Health, Michael W Adler France. Yann Bourgueil is a Research Director, Institut 7 Obesity-control policies in Europe de Recherche et Documentation en Economie Philipa Mladovsky and Caroline Rudisill de la Santé (IRDES), Paris, France. Chantal Cases is Director, Institut de Recherche et Documentation en Economie de la Santé Focus on France (IRDES), Paris, France. 10 French health system reform: recent implementation and Isabelle Durand-Zaleski is Head of Department future challenges at the Department of Public Health, APHP Chantal Cases hôpital Henri Mondor, Paris, France. 12 Interview with Xavier Bertrand, French Minister of Health Anne-Maree Farrell is Lecturer, School of Law, University of Manchester, Manchester, UK. 15 Pharmaceutical policy in France: a mosaic of reforms Carine Franc is a Researcher at the Institut Nathalie Grandfils and Catherine Sermet National de la Santé et de Recherche Médicale and the Institut de Recherche et Documentation 18 Health targets in France: role of public health and social en Economie de la Santé (IRDES), Paris, health insurance reform laws France. Isabelle Durand-Zaleski Jack Friedman is a Post Doctoral Fellow, Department of Comparative Human Devel- 21 French hospital reforms: a new era of public-private opment, University of Chicago, Illinois, USA. competition? Zeynep Or and Gérard de Pouvourville Nathalie Grandfils is a Research Fellow, Institut de Recherche et Documentation en Economie 24 Health care human resource policy in France de la Santé (IRDES), Paris, France. Yann Bourgueil and Yvon Berland Melanie Lisac is Project Manager, International Network Health Policy & Reform Coordinator, 27 New governance arrangements for French health insurance Bertelsmann Stiftung, Gütersloh, Germany. Carine Franc and Dominique Polton Anna Melke is a former journalist and currently a PhD candidate, School of Public Administration, University of Göteborg, European Snapshots Sweden. 30 A new policy agenda in Sweden: choice and deregulation Robert Mendelsohn is Edwin Weyerhaeuser Anna Melke Davis Professor, Professor of Economics, and Professor in the School of Management, Yale 31 Health care reform in Germany: is Bismarck going Beveridge? School of Forestry and Environmental Studies, Melanie Lisac and Sophia Schlette New Haven, Connecticut, USA. Health Policy Philipa Mladovsky is a Research Assistant at LSE Health, London School of Economics and 33 Stem Cell Politics Political Science, UK. Anne-Maree Farrell Zeynep Or is Senior Economist, Institut de 36 The challenges facing mental health reform in Romania Recherche et Documentation en Economie de la Jack R Friedman Santé (IRDES), Paris, France. Dominique Polton is Director of Strategic Research and Development, Caisse Nationale d’Assurance Maladie, Paris, France. Evidence-informed Decision Making Gérard de Pouvourville is Research Director, 40 “Risk in Perspective” Risk communication: a neglected tool in Centre National de la Recherche Scientifique and also at Institut National de la Santé et de protecting public health Recherche Médicale, Paris, France. 43 “Bandolier” Delivering better health care 2 Caroline Rudisill is a Research Assistant at LSE Health, London School of Economics and Political Science, UK. Catherine Sermet is a Research Director, Institut Monitor de Recherche et Documentation en Economie de la Santé (IRDES), Paris, France. 46 Publications 47 Web Watch Sophia Schlette is Project Director, International Network Health Policy & Reform 48 News from around Europe Coordinator, Bertelsmann Stiftung, Gütersloh, Germany. Eurohealth in perspective Objectives Backed by experts The aim of Eurohealth is to bridge the The Editorial Team is based at LSE Health gap between the scientific and policy- and
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