French Health Sector White Paper Goes To Premier

The French government must fix major financial and public health objectives for the national health service, says the White Paper on the Health Care and Health Insurance System, which has been sent to Premier Edouard Balladur. Its authors are Raymond Soubie, former social policy adviser to Jacques Chirac and Raymond Barre, Christian Prieur, ex-director of the CNAM health fund, and Jean-Louis Portos, professor of medicine and medical adviser to a leading social fund.

The system has potential for improving productivity and quality and can be reformed without calling into question the principles on which it is based, they say. Current spending controls must be complemented by more constraints on doctor-generated spending, but "countries where the social security cover of patients is the most extensive are not those where health spending increases the fastest," and "the precise proportion of costs left to be paid by insured people does not have a real influence on health care consumption trends." They reject raising patients' share of costs or distinguishing between greater and lesser medical risks, and counter most French medical opinion by saying that economic regulation and spending control exercised through health care professionals are complementary rather than incompatible.

"Quick Action Vital" Speedy reform is vital because France's "lax" system does not permit evaluation of the quality of its medical practices. "Control of spending is a stimulant to improve the effectiveness of the system and the quality of health care," say the authors. Health service financing problems lead to brutal measures such as lowering reimbursement levels, and the current system, with a forecast deficit of 60 billion French francs ($11.09 billion) for 1994-95, is economically unacceptable. Their key proposals are that: