1. Kos September 2005Pr M.Samuelson1 Why do we need a European Forum for Primary Health care ? Is France concerned ? Marianne Samuelson Kos-Grece 2005

2. Kos September 2005Pr M.Samuelson2 French Health care system Main features Fee for service payment GPs have no real gate keeping function and there is no regulation of the circulation of patients within the system Unequal distribution of GPs throughout the country Most specialists are in private practices in ambulatory care A very complex health insurance system

3. Kos September 2005Pr M.Samuelson3 French context Social changes –Medical demography –Workload acceptance –Consumers/citizens demands for transparency/quality Healthcare system changes –Not a Primary Health Care centred system –Quality proposed as a regulation instrument

4. Kos September 2005Pr M.Samuelson4 System organised for acute episodes of care System centred on acute episodes Patient role not emphasised Follow up sporadic and not organised Prevention is neglected

5. Kos September 2005Pr M.Samuelson5 European countries with strong and weak primary care systems Strong UK Denmark Spain The Netherlands Italy Finland Weak Portugal Belgium Greece Germany France

6. Kos September 2005Pr M.Samuelson6 Primary Care Scores, 1980s and 1990s Belgium0.80.4 France -0.3 Germany0.50.4 United States0.20.4 Australia1.11.1 Canada1.21.2 Japan - 0.8 Sweden1.20.9 Denmark1.51.7 Finland1.51.5 Netherlands1.51.5 Spain-1.4 United Kingdom1.71.9 1980s1990s Starfield 1998

7. Kos September 2005Pr M.Samuelson7 Primary Care Score vs. Health Care Expenditures, 1997 (B. Starfield 2000) US NTH CAN AUS SWE JAP BELFR GER SP DK FIN UK

8. Kos September 2005Pr M.Samuelson8 Average Rankings * for Health Indicators in Infancy, for Countries Grouped by Primary Care Orientation Lowest 9.5 7.8 11.5 8.8 (Belgium, France Germany, US) Middle7.35.35.56.0 (Australia, Canada, Japan,Sweden) Highest4.87.84.66.4 (Denmark, Finland, Netherlands, Spain, UK ** ) Low BirthNeonatalPostneonatalInfant WeightMortalityMortalityMortality (1993)(1993)(1993)(1996) *Best level of health indicator is ranked 1; worst is ranked 13, thus, lower average ranks indicate better performance. **England and Wales only Starfield 1999

9. Kos September 2005Pr M.Samuelson9 Why was France ranked first by WHO in 2000 Availability of supply of providers High degree of freedom for physicians and patients Few restriction in the range of services covered by the heatlth insurance system Easy access Absence of waiting list Patient satisfaction

10. Kos September 2005Pr M.Samuelson10 European challenges / French context Aging population Chronic diseases Cultural and ethnical diversity Scientific progress Patient involvement Tasks division among health care providers

11. Kos September 2005Pr M.Samuelson11 Two questions Is it still possible to maintain the ideal synthesis of solidarity, liberalism, and pluralism ? Claude Le pen N Engl J Med November 2004 Is French health care system adapted to face the future European challenges

12. A turning point : last opportunity for a model or decline… Pr Marianne Samuelson

13. Kos September 2005Pr M.Samuelson13 Why could France benefit from the European forum for primary care Connect Primary health care providers of different professions Connect providers, researchers, policymakers from different European countries Promote communication with policymakers at a local national and European level to create a common vision Benefit from monitoring policies on their relevance to primary care. ……….. France has a lot to gain !