Activities and Organisational Structure

A Mixed System

The first key feature of the French health system is its mix of public and private providers (hospitals, for example, on the one hand and private clinics and practitioners on the other). Another characteristic is the large component of cost sharing. Health care costs are not borne directly by patients but paid for by the statutory health insurance scheme (in the form of reimbursements or direct payment by the health insurance funds), while the different health insurance funds are financed by contributions based on professional earnings and other forms of income.

The state is the main actor of the health care sector. It plays a direct role in the funding and provision of health care and regulates the relations between funding institutions, patients and health professionals.

The state is thus responsible for (either directly or through specialist bodies):

• planning health care (increasingly at the regional level),
• general public health policy, including preventive healthcare, health watch, policies to combat diseases and tobacco, alcohol and drug addiction,
• training health actors (doctors, nurses, paramedical staff, etc.) – another aspect that the regions are now involved in,
• appointing hospital doctors and hospital accreditation,
• setting hospital budgets (with the assistance of the health insurance scheme),
• participating in the funding of hospital modernisation programmes,
• monitoring quality standards in hospitals,
• drugs policy (authorisation, pricing and monitoring),
• guidelines and supervision of health care and health prevention bodies, as well the system of health care supply as a whole.

Beginning in the nineteen eighties, a number of bodies were set up to improve health safety and prevention, exercising some of the responsibilities of the state in this area:

• National Biomedicine Agency (ABM)
• French Food Safety Agency (AFFSA),
• French Health Products Safety Agency (AFSSAPS),
• French Environmental Health Safety Agency (AFSSE),
• National School of Public Health (ENSP),
• French Blood Donors Institute (EFS),
• French National Health Authority (HAS),
• National Institute for Health Education and Prevention (INPES),
• Health Watch Institute (InVS),
• French Nuclear Protection and Safety Institute (IRSN).

Health watch activities are implemented among others by the Communicable Diseases Computerised Surveillance Network (RNTMT).

Social security funding and operating mechanisms are determined by parliament, which each year passes a Social Security Funding Act (LFSS).

Consultation on health system operation is provided through a National Health Conference, and conferences are also held at the regional and territorial levels.