French patients will have to go through family doctors to access specialists
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《英国医生杂志》
The health minister, Philippe Douste-Blazy, last week unveiled the French government抯 plan to reorganise and streamline the country抯 healthcare system to reduce the �12.9bn (?.7bn; $15.5bn) annual deficit and pay back the �32bn debt. It represents at least the fourteenth attempt to reform the French health system since 1975.
The plan, which he presented on television on 17 May, should save up to �15bn a year by 2007 by cutting costs and increasing charges. The most radical change requires patients to pay a non-reimbursable �1 for each medical consultation, to both save money and give people a "sense of responsibility" for their health care.
"Our system is failing, it is without a pilot, and no one is responsible," said Mr Douste-Blazy. "I抦 here to defend a new system."
As part of the reorganisation, family doctors are to be the starting point for all medical consultations, and they will use a new computerised medical records system.
The family doctor—regardless of whether he or she is a GP or a specialist—will be responsible for recommending a specialist. Without such a referral, patients will either pay more for the visit or be reimbursed less. The government hopes this will save �3bn by 2007.
The computerised medical record will be accessible by all doctors and track a patient抯 visits to all medical professionals to prevent unnecessary, repetitious treatment.
On a visit on Monday 24 May to a clinic in Toulouse where the computerised medical record is being tested, Mr Douste-Blazy told French television news that he expected the system to save �3.5bn annually. The clinic, which has been testing the system for two years, showed how all of a patient抯 visits to any doctor would be kept online, be they written reports of the patient抯 examinations or videos, such as one shown of a patient抯 bronchial fibroscopy. This is expected to prevent patients from repeating examinations at the expense of the healthcare system as physicians will be able to see whether or not such test have already been performed.
Patients?computerised records will be accessed by all doctors and will show all consultations with all medical professionals—to prevent unnecessary treatment. Patients will have an electronic identity card—similar to the current one but with their photograph on it to prevent fraudulent use.
The �1 consultation fee, which will also apply to consultations for such things as blood tests and x rays examinations but will not apply to poor families or children, should save up to �1bn.
Doctors are being asked to write fewer sick notes, and those who write too many will lose the right to issue such notes.
The government will continue to encourage the use of generic drugs through a forfeiture reimbursement plan started last year, while also increasing the number of generic drugs on the market through changes in French data laws to draw France into alignment with a European Union directive on ten-year data protection for pharmaceutical products.
Mr Douste-Blazy also called for taxable retired people to pay an increase of 0.4% on a social security tax designed to reduce the deficit, and the base from which the tax is taken from workers?salaries will be increased from 95% to 97% of the salary.
The percentage of salary and revenue taxes for social security paid by companies will also rise, and the government will contribute �1bn through taxes raised from business and tobacco sales.
A special tax of 0.5% on workers?salaries introduced in 1996 and scheduled to end in 2014 to pay off the social security debt will be extended for at least eight years to pay the �32bn debt.
Although some labour unions have criticised the programme, other spokesmen for the unions, such as Dr Michel Combier, president of the Union of Family Doctors, have seen some aspects of the changes as positive. Dr Combier told French television in Toulouse on 24 May. "It is there first of all for reasons of quality, and should not be looked at first for cost saving purposes. It is an investment."
Three labour unions, including the country抯 largest, made a joint statement opposing the proposals and calling for a day of national protest on 5 June.
On Monday two more labour unions agreed to join the day of national protest. Their statement came before another meeting between labour unions and Mr Douste-Blazy on Monday evening.
Among the complaints, the unions say that although the minister is consulting them, he is not laying out all of the details of the plan. Several new details have been made public by the minister in the days after the presentation, without consultation with the unions.
Gaby Bonnand, the national secretary of the CFDT union (the French Federation of Democratic Labour), in an interview in Le Monde called the programme "a superficial sweeping" that does not guarantee access of quality treatment to everyone.(Paris Brad Spurgeon)
The plan, which he presented on television on 17 May, should save up to �15bn a year by 2007 by cutting costs and increasing charges. The most radical change requires patients to pay a non-reimbursable �1 for each medical consultation, to both save money and give people a "sense of responsibility" for their health care.
"Our system is failing, it is without a pilot, and no one is responsible," said Mr Douste-Blazy. "I抦 here to defend a new system."
As part of the reorganisation, family doctors are to be the starting point for all medical consultations, and they will use a new computerised medical records system.
The family doctor—regardless of whether he or she is a GP or a specialist—will be responsible for recommending a specialist. Without such a referral, patients will either pay more for the visit or be reimbursed less. The government hopes this will save �3bn by 2007.
The computerised medical record will be accessible by all doctors and track a patient抯 visits to all medical professionals to prevent unnecessary, repetitious treatment.
On a visit on Monday 24 May to a clinic in Toulouse where the computerised medical record is being tested, Mr Douste-Blazy told French television news that he expected the system to save �3.5bn annually. The clinic, which has been testing the system for two years, showed how all of a patient抯 visits to any doctor would be kept online, be they written reports of the patient抯 examinations or videos, such as one shown of a patient抯 bronchial fibroscopy. This is expected to prevent patients from repeating examinations at the expense of the healthcare system as physicians will be able to see whether or not such test have already been performed.
Patients?computerised records will be accessed by all doctors and will show all consultations with all medical professionals—to prevent unnecessary treatment. Patients will have an electronic identity card—similar to the current one but with their photograph on it to prevent fraudulent use.
The �1 consultation fee, which will also apply to consultations for such things as blood tests and x rays examinations but will not apply to poor families or children, should save up to �1bn.
Doctors are being asked to write fewer sick notes, and those who write too many will lose the right to issue such notes.
The government will continue to encourage the use of generic drugs through a forfeiture reimbursement plan started last year, while also increasing the number of generic drugs on the market through changes in French data laws to draw France into alignment with a European Union directive on ten-year data protection for pharmaceutical products.
Mr Douste-Blazy also called for taxable retired people to pay an increase of 0.4% on a social security tax designed to reduce the deficit, and the base from which the tax is taken from workers?salaries will be increased from 95% to 97% of the salary.
The percentage of salary and revenue taxes for social security paid by companies will also rise, and the government will contribute �1bn through taxes raised from business and tobacco sales.
A special tax of 0.5% on workers?salaries introduced in 1996 and scheduled to end in 2014 to pay off the social security debt will be extended for at least eight years to pay the �32bn debt.
Although some labour unions have criticised the programme, other spokesmen for the unions, such as Dr Michel Combier, president of the Union of Family Doctors, have seen some aspects of the changes as positive. Dr Combier told French television in Toulouse on 24 May. "It is there first of all for reasons of quality, and should not be looked at first for cost saving purposes. It is an investment."
Three labour unions, including the country抯 largest, made a joint statement opposing the proposals and calling for a day of national protest on 5 June.
On Monday two more labour unions agreed to join the day of national protest. Their statement came before another meeting between labour unions and Mr Douste-Blazy on Monday evening.
Among the complaints, the unions say that although the minister is consulting them, he is not laying out all of the details of the plan. Several new details have been made public by the minister in the days after the presentation, without consultation with the unions.
Gaby Bonnand, the national secretary of the CFDT union (the French Federation of Democratic Labour), in an interview in Le Monde called the programme "a superficial sweeping" that does not guarantee access of quality treatment to everyone.(Paris Brad Spurgeon)