User:Pahpaha/Health care


 * This article is about the French public system and its specific issues. For a broder view, see Health care system. For more information on public services, see Social Security in France and Social protection in France

Overview
The government hold a central role in administering the health system, as its role is to garantee public interest and to improve health of the population. However, it does not interfere directly in the administration of health, but controls it very closely. The funding of the system is garateed by the Social Secrity, a ^public administration, an entity which is different from the State, but which partially depends on it. In few cases the government directly fund health care. Most often it contends itself in controlling the funding of health care, the health professionals, and patients, so as to control.

More precisely, the State control general problems of public health: prevention, health monitoring, fight against major diseases and problems (drug addiction, alcoholism). It also provides training for medical personnel and hospital staff, and controls the quality of infrastructures and care, supervises the Regional Agencies of Hospitalization (Agences Régionales d'Hospitalisation. It also controls the funding of health care, that is the amount of social contributions the rules of population coverage.

The different levels of administration for health care are:
 * The Ministry of Health, the Ministry of Social Affairs and the Ministry of the Economy, which make part of the government, can supervise the health care system. The Ministry of Health has a direct control on hospitals. The Ministry of the Economy and the Ministry of Social Affairs supervizes the funding of Social Security.
 * A lot of national entities, organisms and agencies, more or less dependant from the central government, contribute to the organization and the supervision of the French health care system. They generally have not executive power and their rolke is mainly to supervize the system.
 * At local level, i.e. in regions, the DRASS (Directions régionales des affaires sanitaires et sociales), and in departments, the DDASS (Directions départementales des affaires sanitaires et sociales) ensure the implementation of national policies, the definition and runregional and local actions.
 * Regional agencies of hospitalization (ARH) were instituted in 1996, to manage hospitals at a regional level.

Since 1996, the Parliament has published an annual report in which it set objectives for the funding and health expanditure. In reality, these objectives have never been respected. The Parliament also vote laws relative to hospitals and the health care system.

Organization of the insurance system
Social protection against health problems is mainly guaranteed by the Social Security administrations, a public administration under close state supervision. This insurance is compulsory. It is managed by the "health branch", one of the fours "branches" of the Social Security. There are also health care provided by private insurance for additional protection, but it is not compulsory and it is not dependant from the Sate. As the major part of health care expenditure is either guaranteed or pais by the Social Security, it has a dominant role in financing medical care. It currently supports two fourth of health spending. However, a growing number of people additional insurance.

Currently, the entire population is covered by health insurance. Most are covered on a professional (workers) or family (retired) basis. The members of their families (children and/or wives) are sometimes automatically covered (depending on the age of the children, their status, the status of the wife, etc). The unemployed have also access to social protection. Finally, the Universal health coverage allows anyone which is not cevored by these three systems to receive financial reimbursement for health care.

As the three other branches of the Social Security, the health insurance is divided on different regimes, i.e. people have different treatment due to the specificities of their jobs.


 * the "General Scheme of Social Security" is the normal regime, for most wage-earners. It covers about 80% of the population. It is managed nationally by the National Health Insurance for Employees (Caisse Nationale d'Assurance Maladie des Travailleurs Salariés or CNAMTS). This agency manage the general scheme, it supervises its financing, controls the infrastructures and the medical professionals.
 * the Agricultural Social Insurance Agency covers farmers and agricultural workers and their families, approximately 9% of the population.
 * the regime for independent such as artisans, merchants and all non-wage-earning workers, 6% of the population.
 * the special regime, for civil servants and specific professions (this regime is well-known for the retirement branch: see French special retirement plan. However, the special regimes also include specific advantages for the health, the family and the work insurances).

The UNCAM (Union Nationale des Caisses d'Assurance Maladie) is an organism which lead and organized negociations between syndicates, the government and mediacl professionals to make decisions about the funding og the system. The negociations include decisions on the annual budget of the insurance, the amount of the contributions, the persentage of expenditure paid back by the state.

Care provided by the system
- Les établissements hospitaliers - Les professions de santé - Les dispensaires et centres de soins - La pharmacie

Care and reimbursement
Every French citizen over 16 years can choose a doctor who will provide him with appropriate care. This doctor may be a generalist or a specialist, providing he/she accept the function. It is possible to change doctor. The physician chosen by the patient maintains a medical record for the patient, he can prescribe additional medical care and referrals to another doctor, for example a specialist or to a hospital or another health professional. All medical procedures performed or recommended by the attending physician are payed back at the standard rate.

However, if the patient does not choose an attending doctor or if directly consults a specialist, it is no longer payed back, or less well paid, and the part of the expenses he/she is charged with will will be higher than if made by the physician.

A certain fraction of the cost is borne by the insured: it is the "user fees". This personal contribution amounts to at least 1 euro and can reach 18 euros it the price of the care is higher than 90 euros.

Some doctors accept to fully adhere to the Conventions stated by national negociations; their tariffs respect the national standarts. These doctors are part of the "sector 1". Other physicians make part of the "sector 2", they are free to set their fees.

Hospitals
Hospitals in France, either private or state-owned, are totally controlled by the State? In fact they are led by the ARH, agencies created by the government to manage hospitals at a regional level.