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Origin of hospital in the
12the and 13th century with the hotels dleu
Creation of modern hospitals starting with
the maison royale de santé and the influence of the 1789 revolution on healthcare
19th Century Reforms
Nationalization of hospitals and the introduction of municipal healthcare management
The creation of ministry of health in
1920 and early forms of social security
Establishment of the comprehensive social security system in
1945
universal healthcare coverage in
1999, with a focus on public and employer/employee contributions
Frances division of healthcare services
public, private non-profit and private for-profit hospitals, their rules and methods for funding
Non-profit
usually religious affiliation, lower costs, charitable donations help offset costs of healthcare
Private for-profit
elective surgeries, more expensive, still integrated into healthcare system for france (some is still covered, just not a lot)
General Practitioners (GP) and Specialists
Free choice to see whoever GP
Can also see specialist before going to specialist - but not recommended
Assurance Maladie
national health insurance system
mandatory health insurance?
yes
Meaning that every legal resident is automatically covered by national health insurance
This includes foreign residents who have been living in the country for more than three months
Payroll contributions
employers and employees contribute a percentage of wages to fund healthcare
Additional taxes
There are taxes on income, capital, and even some forms of consumptions such as tobacco and alcohol which go toward healthcare funding
Complementary private insurance (mutuelles)
patients are still responsible fro some out-of-pocket expenses, such as copayments for doctor visits and certain medical procedures
About 95% of the population holds complementary private insurance known as mutuelles, which help cover these additional costs
France has a mixed system
both public and private providers deliver care
Most hospitals are
publicly owned and offer most of the specialized care (well funded)
Private hospitals and clinics,
often not for profit provide many elective surgeries
Both public and private hospitals are
integrated into the national health insurance system, with patients receiving reimbursement regardless of where they are treated
Reimbursement system
Healthcare services in france are typically paid for upfront by the patient but they are reimbursed by the assurance Maladie
Reimbursement rates vary by service
Doctor visits are usually reimbursed at 70% of the cost
For those with chronic diseases (cancer, diabetes, etc) the government covers 100% of medical costs related to those conditions
State medical Assistance (Aide Médicale de l’Etat, AME)
For undocumented migrants or those who are otherwise ineligible for standard coverage, France provides AME which allows access to basic healthcare services
Complementary Universal Health Coverage (CMU-C)
For those with low incomes, the CMU-C provides free complimentary insurance, reducing or eliminating out of pocket costs
This ensures that even those with financial constraints can access comprehensive healthcare
Government regulation
government plays a significant role in regulating the costs of healthcare, setting fees for medical services and negotiating drug prices to keep healthcare affordable
Cost-sharing
Although the system covers most healthcare costs, there is some cost-sharing between the state and patients, which helps contain excessive use of services
This includes modest co-payments for consultations, medications, and procedures, but additional coverage ny Mutuelles keep patient burden low
french healthcare system faces challenges such as
rising healthcare costs, an aging population, and increasing demand for chronic disease management
Reforms have focused on
Improving cost-efficiency (eg, hospital budgeting, care coordination)
Addressing workforce shortages, especially in rural areas
Integrating digital healthcare innovations (like electronic medical records)
Universal coverage
all legal residents are covered, ensuring access to healthcare regardless of income or employment
High quality care:
ranks high in terms of healthcare quality, and life expectancy, care is available in both public and private institutions
Affordability
patients face minimal out of pocket costs due to high reimbursement rates and private complementary insurance
Flexibility
patients have the choice to choose their doctors and hospitals including specialists
Disadvantages
Financial sustainability challenges: rising healthcare costs are due to an aging population and increasing chronic disease treatment put pressure on system
Administrative complexity: the systems structure involves many layers of reimbursement, requiring administrative effort for providers and patients
Workforce shortages: some rural areas face shortages limiting access for certain populations
