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Système de Santé Français
Transcript of Système de Santé Français
A country presides european union for a six months period
Now, it's Italy until 31st of Dec. 2014
507,4 M. people
31 607 $/hab (IMF )
Article 25 of the Universal Declaration of Human Rights adopted by the United Nations in December 1948
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
Right to health
I – Different Health Systems
1) Bismarck form
2) Beveridge form
3) Private form
II – French Health System
2) Financial model & organization
3) French specificities
Three groups of elements:
responsible administration / finance
Promote, preventing the development of risk factors or diseases
Healing, relieve suffering
Reduce the functional and social consequences of disease
The ideal health system must be:
Global: Make every sector (prevention ++)
Accessible: geography (proximity), economics (cost) and information
Efficient: Technology and Economics
Acceptable: consent of the governed
Schedulable and assessable
Flexible and modifiable: adapt to the changes of disease (AIDS), the technical progress (MRI) or socio-economic
Solvent: limited resources
The diversity of systems
Objectives similar but different answers, depending on
The type of institutions taking care of the health need (role of the state, mutual and private insurance)
From the way of organizing the provision of care (instead of public hospitals, the role of general physicians, the importance of private medicine)
Choice of your doctor and maintaining a private practice
The priorty given to market
Classification of the different Health Systems
Because there is a but!
1) Bismarckian model
The policy of Chancellor Bismarck (Conservative) at the end of the nineteenth is marked by two concerns: the fight against unions and fight against the rise of the Socialist Party.
In consideration of a repressive policy, the state has taken responsibility to institutionalize social protection: compulsory social insurance emerged in Germany from 1883.
Funded and managed by stakeholders
Companies and workers
Contributions: based on wages;
managed by representatives of companies and workers (unions called "social partners”).
The right to health care and health insurance are the attributes of the worker and of his "beneficiaries" (his family and those who live with him).
In essence, this model generates excluded people.
Financial imbalances in economic and demographic are unavoidable.
The large number of assurance cases can result in a medicine at different speeds.
the main challenges
Founded in Germany by Otto von Bismarck (1815-1898)
Based on compulsory insurance:
1883: Health Insurance
1884: accident insurance
1889: disability pension
Funded by contributions from employees and employers
Managed by the representatives of employees and employers
"Gentlemen of the Democrats will play the flute in vain
when the people will realize that the princes are concerned
his well-being "OVB
A Bismarckian model (system of mandatory social insurance, financing and management is entrusted to the insured and their employers)
A Beveridge model (National Health Service, tax financing)
Private model (individual funding private assurance and voluntary private market production)
Three theorical models of Health Protection
2) A Beveridge form
Founded in England by William Beveridge (1879- 1963)
In 1942, William Beveridge writes a report on Social Security at the request of Churchill.
Based on solidarity
Financed by taxes
Managed by the state
The right to health and health insurance is an attribute of citizenship.
Funded by taxes amount fixed by Parliament.
The beneficiaries: all citizens and foreigners legally resident.
Free health care, a priori equal access.
Founding principles: the three "U"
Universality: Every citizen, regardless of employment status, would be protected against all social risks.
Unit: A single administration would manage each risk.
"Unicity": Each benefit of aid according to their needs and regardless of income
3) The private model
No obligation of assurance
Freedom of choice
Minimum of safety net
Competition between insurers and producers
Financing of health expenditures is provided by the individuals themselves or by private insurers
Health professionals and institutions in the private sector (for profit or not)
The government intervention is minimized and very focused
Et la France alors?
Liberté Egalité Fraternité
66 M people
GDP : 2059,9 G € (5°)
Population aging is the increasing proportion of older people in a population. The demographic transition inevitably causes an aging population.
II – French Health System
2) Financial model & organization
3) French specificities
Access to health care is a right for every individual in our society.
It is the State's responsibility to ensure that every individual, regardless of their financial means, place of residence and origin, access to quality care in the context of national solidarity.
The State shall, in the framework of a democratic debate, apply a national health policy.
In France, the population continues to grow
Steady increase in life expectancy
The request (aging ...) and supply (technical progress ...) interacting care continuously, the result of a rise needs.
This results in higher costs reimbursed by social security contributions From assets, the proportion tends to decline in the French population (depends on its age for retirement).
Structures of regulation
ANSM (Agence Nationale de la Sécurité du Médicament et des produits de santé) to ensure efficiency, quality and appropriate use of health products man.
HAS (Haute Autorité de Santé) to help maintain a system of joint health and enhancing the quality of care for the benefit of patients.
Social Security is in charge of three risk
Creation in 1945
Based on the work: contributions
Protected persons who are "insured"
Branch of the Social Security Insurance = disease
75% of health expenditure borne by the Disease Assurance
One of the core values of the French model:
- The principle of solidarity
• A heterogeneous system
- Of particular complexity, whose equity is not certain
- Based on compulsory insurance
• Public Insurance
- 1945 Social Security
- 1956 unemployment insurance
• Private Insurance
- Funded by the contributions of employees and employers
- Managed by the state and the social partners
Including a logical Beveridge
- Enhanced Support for the poor
• Social Minima (old age, RMI, etc.)
• Social Security (CMU)
- Funded by the tax on labor income and capital
2) Financial Model & organization
A financial situation due to demographic one
Employer contributions and salary: 65%
Reimbursements are based on rates negotiated between unions and CNAM
Co-payment = amount not reimbursed to the patient
3 types of exemption from co-payments (= support to100%):
Long term affection
Time hospitalization higher than 30 days
Status of insured: pregnancy, disability, work accident
Be careful !
Weight pros and cons of each system!
What are the different systems?
How to measure its efficiency?
What is a good health system?
Docteur Albert Schweitzer
1952 Nobel Prize
Went to Africa & India...