Friday, November 6, 2009

Primary care in France - I

Health Affairs, a leading health policy journal in the United States, recently published a report of a study of primary care across 11 nations. The study found both advantages and shortcomings in many countries with the US lagging in insurance coverage and information technology adoption. The study included France in its surveys but, due to some technical problem with the surveying firm (I am told) the response rate from that country was very low, only 7%. The article does report data from France but urges caution in the interpretation due to the survey problems.

France is a bit awkward when it comes to international comparisons that focus on primary care. The nation has excellent health outcome measures and it noted, (if not notorious) for coming out on top in a WHO-sponsored ranking of nations and their health and health systems. However, France ranks low on indices of primary care, falling at the bottom with Belgium, Germany, and the United States (see Starfield, B. Primary Care: Balancing Health Needs, Services and Technology. Oxford, 2008, p. 347.)

The November Health Affairs article summarized the elements of the health systems of 11 countries and described France, under the rubric of “Primary care doctor role and payment” as not having a requirement for people to register and some national incentives for a gatekeeper role for primary care. In reality, France does have a universal requirement for all residents to register with a physician. That law, passed in 2005, created the médecin traitant system and, by 2007, 87% of those eligible had registered with a physician and 99% of those physicians were general practitioners. An analysis of that program was published by IRDES in March of 2009 (Naiditch M. The preferred doctor scheme: A political reading of a French experiment of Gate-keeping. DT no. 22). Despite this attempt to apparently strengthen the French system more toward a primary care orientation, the results of the médecin traitant program are seen to be largely ineffective in coordinating care and re-structuring the system.

France is looking to organize its primary care services more rationally and effectively. The new re-organization plan, “Loi Hopital, Patient, Santé et Territoire” (HPST) for sees a greater emphasis on primary care. The Institute de Recherce et Documentation en Économie de la Santé (IRDES) organized a conference looking at lessons that could be gleaned from other nations. The conference papers are posted on the IRDES web site.

I will have more about the work of IRDES on primary care in future posts.

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