Health Care Provision
The health professions
France employs about 1.7 million health-sector professionals. They include members of the professions governed by the Public Health Code and other socio-professional groups.
The health-sector professions can be divided into two main categories:
- the medical professions (general practitioners, specialists, dental surgeons, pharmacists etc.),
- the paramedical professions (nurses, nursing auxiliaries, physiotherapists, laboratory technicians, X-ray operators, etc.).
In terms of activity status, the health professions comprise:
- the salaried health professions (which include doctors and paramedics working in public or private hospitals),
- the self-employed professions (doctors and paramedical staff).
The biggest of the health professional groups (accounting for 47% of all health sector jobs) works in the public hospital sector. This sector has witnessed a significant increase in staffing levels, which have grown by 31.3% between 1985 and 2002, with women playing an increasingly preponderant role (76% of all jobs).
Nurses, nursing auxiliaries and clerical and technical staff account for about three-quarters of all health sector staff.
Staff employed in public hospitals have a special status as state hospital sector employees. Civil servant status does not apply to doctors and pharmacists employed in public health institutions. University hospital doctors have dual status as civil servants due to their teaching and research responsibilities, and state hospital sector employees due to their medical work. In the private non-profit and for-profit hospitals, health professionals are governed by private-sector labour law, or self-employed as in the case of practitioners working in clinics.
Independent (private) medical practice is governed by a certain number of principles: freedom for doctors to set up practice where they choose, fee-for-service remuneration of doctors, and freedom of patients to choose their doctor. In 1998, 75% of all general practitioners and 68% of all specialists worked in private practice. A numerus clausus system fixes the number of medical and dental students to be admitted to medical school each year (5,700 medical students in 2004). Some branches are experiencing difficulties attracting students however, in particular paediatrics, obstetrics, anaesthesia and psychiatry. There are also wide disparities in the geographical distribution of doctors. Though the national average is 335 doctors per 100,000 inhabitants, this figure is 424 for the Paris region and 416 for the Provence-Alpes-Côte d’Azur region, while Picardy has only 251 doctors per 100,000 inhabitants. Specialists too are in greater supply in the big cities.
Private practitioners are remunerated on a fee-for-service basis and are allowed to combine private practice with salaried work.
