IRDES.
European Observatory on Health Systems and Policies, LSE Health.
Health Syst Transit. 2023 Jul;25(3):1-276.
This review of the French health system analyses recent developments in health organisation and governance, financing, healthcare provision, recent reforms and health system performance. Overall health status continues to improve in France, although geographic and socioeconomic inequalities in life expectancy persist. The health system combines a social health insurance (SHI) model with an important role for tax-based revenues to finance healthcare. The health system provides universal coverage, with a broad benefits basket, but cost-sharing is required for all essential services. Private complementary insurance to cover these costs results in very low average out-of-pocket (OOP) payments, although there are concerns regarding solidarity, financial redistribution and efficiency in the health system. The macroeconomic context in the last couple of years in the country has been affected by the Covid-19 pandemic, which resulted in subsequent increases of total health expenditure in France in 2020 (3.7%) and 2021 (9.8%). Healthcare provision continues to be highly fragmented in France, with a segmented approach to care organization and funding across primary, secondary and long-term care. Recent reforms aim to strengthen primary care by encouraging multidisciplinary group practices, while public health efforts over the last decade have focused on boosting prevention strategies and tackling lifestyle risk factors, such as smoking and obesity with limited success. Continued challenges include ensuring the sustainability of the health workforce, particularly to secure adequate numbers of health professionals in medically underserved areas, such as rural and less affluent communities, and improving working conditions, remuneration and career prospects, especially for nurses, to support retention. The Covid-19 pandemic has brought to light some structural weaknesses within the French health system, but it has also provided opportunities for improving its sustainability. There has been a notable shift in the will to give more room to decision-making at the local level, involving healthcare professionals, and to find new ways of funding healthcare providers to encourage care coordination and integration.
这篇法国卫生系统综述分析了近期卫生组织和治理、融资、医疗保健提供、近期改革以及卫生系统绩效方面的发展。尽管在预期寿命方面仍存在地理和社会经济不平等，但法国的整体健康状况仍在持续改善。该卫生系统结合了社会健康保险（SHI）模式和基于税收的收入在为医疗保健提供资金方面的重要作用。该卫生系统提供全民覆盖，涵盖广泛的福利篮子，但所有基本服务都需要分担费用。为支付这些费用而提供的私人补充保险导致平均自付费用（OOP）非常低，尽管人们对卫生系统中的团结、财务再分配和效率表示关注。过去几年该国的宏观经济背景受到了新冠疫情的影响，导致法国 2020 年（3.7%）和 2021 年（9.8%）的总卫生支出增加。法国的医疗保健仍然高度分散，对初级、二级和长期保健的护理组织和资金采取了分段方法。最近的改革旨在通过鼓励多学科小组实践来加强初级保健，而过去十年的公共卫生工作重点是加强预防战略和解决生活方式风险因素，如吸烟和肥胖问题，但收效甚微。持续面临的挑战包括确保卫生劳动力的可持续性，特别是在医疗资源不足的地区，如农村和较贫困社区，确保有足够数量的卫生专业人员，并改善工作条件、薪酬和职业前景，特别是对护士，以支持留任。新冠疫情暴露了法国卫生系统中的一些结构性弱点，但也为提高其可持续性提供了机会。在地方一级，让更多的医疗保健专业人员参与决策，并找到为医疗保健提供者提供资金的新方法，以鼓励协调和整合护理方面，已经出现了明显的转变。
