Chevreul Karine, Berg Brigham Karen, Durand-Zaleski Isabelle, Hernandez-Quevedo Cristina
URC Economie de la sante, AP-HP / INSERM / Universite Paris Diderot.
URC Economie de la sante, AP-HP / Universite Paris-Est.
Health Syst Transit. 2015;17(3):1-218, xvii.
This analysis of the French health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The French population has a good level of health, with the second highest life expectancy in the world for women. It has a high level of choice of providers, and a high level of satisfaction with the health system. However, unhealthy habits such as smoking and harmful alcohol consumption remain significant causes of avoidable mortality. Combined with the significant burden of chronic diseases, this has underscored the need for prevention and integration of services, although these have not historically been strengths of the French system. Although the French health care system is a social insurance system, it has historically had a stronger role for the state than other Bismarckian social insurance systems. Public financing of health care expenditure is among the highest in Europe and out-of-pocket spending among the lowest. Public insurance is compulsory and covers the resident population; it is financed by employee and employer contributions as well as increasingly through taxation. Complementary insurance plays a significant role in ensuring equity in access. Provision is mixed; providers of outpatient care are largely private, and hospital beds are predominantly public or private non-profit-making. Despite health outcomes being among the best in the European Union, social and geographical health inequities remain. Inequality in the distribution of health care professionals is a considerable barrier to equity. The rising cost of health care and the increasing demand for long-term care are also of concern. Reforms are ongoing to address these issues, while striving for equity in financial access; a long-term care reform including public coverage of long-term care is still pending.
对法国医疗体系的这一分析回顾了其在组织与治理、医疗融资、医疗服务提供、医疗改革及医疗体系绩效方面的近期发展情况。法国民众健康水平良好，女性预期寿命位居世界第二。民众在医疗服务提供者方面有较高的选择度，对医疗体系的满意度也较高。然而，吸烟和有害饮酒等不健康习惯仍是可避免死亡的重要原因。再加上慢性病带来的沉重负担，这凸显了预防和整合服务的必要性，尽管从历史上看这些并非法国医疗体系的强项。尽管法国医疗体系是一个社会保险体系，但与其他俾斯麦式社会保险体系相比，国家在其中历来发挥着更强的作用。医疗保健支出的公共融资在欧洲处于最高水平之列，而自付费用则处于最低水平之列。公共保险具有强制性，覆盖常住人口；其资金来源包括雇员和雇主的缴款，以及越来越多的税收。补充保险在确保公平获得医疗服务方面发挥着重要作用。医疗服务提供情况较为复杂；门诊服务提供者大多为私立，而医院床位主要是公立或私立非营利性的。尽管健康结果在欧盟中名列前茅，但社会和地域上的健康不平等现象依然存在。医疗保健专业人员分布不均是实现公平的一个重大障碍。医疗保健成本的上升以及对长期护理需求的增加也令人担忧。目前正在进行改革以解决这些问题，同时努力实现医疗服务获取的公平性；一项包括长期护理公共覆盖的长期护理改革仍在等待推进。
