University of Paris 1 Panthéon-Sorbonne, Paris, France.
University of Dijon, Dijon, France.
Lancet. 2016 May 28;387(10034):2236-49. doi: 10.1016/S0140-6736(16)00580-8. Epub 2016 May 1.
Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.
自 1945 年以来，法国的医疗保健服务一直基于一种促进普遍性和平等的社会理念。法国的医疗保健系统基于强制性社会保险，由工人和雇主组织共同管理，由国家控制，并通过高度再分配的财政转移支付提供资金。这种制度经常被描述为法国模式。在本文中，也是《柳叶刀》关于法国系列的第一篇文章中，我们对法国医疗保健的传统观念提出了挑战。首先，我们关注过去几十年影响医疗保健治理的政策和制度变革。我们认为，医疗体系建立在多种机构、政策机制和医疗行为体的基础上，而其治理则以国家主导下的国家监管加强为标志。其次，我们认为，健康保险制度的再分配机制受到健康不平等的阻碍，而健康不平等仍然是实现与法国医疗保健理念相关的正义和团结目标的主要障碍。
