Is France’s envied health care system threatened?

Thousands of French doctors and health professionals will take to the streets in Paris on Sunday to protest against reforms they say will threaten the quality of France's renowned health care system. The leader of the demonstration tells The Local why the government must listen.

Is France's envied health care system threatened?
Doctors take to the streets of Lyon in january to protest health reforms. Photo: Jeff Pachoud/AFP

For doctors in France the issue is clear.

The reputation of the country's health care system as the best in the world is at stake.

In recent weeks France has seen doctors in hospital emergency wards go on strike over working conditions and a police memo warned that hospitals are at breaking point due to a shortage of beds and poor working conditions for staff, all exacerbated by a winter flu epidemic.

“It's like Thatcher's Britain,” said the unions.

Health professionals have long demanded reforms but the minister of health’s bill, set to be discussed in parliament next week, has only served to provoke more anger among family doctors (GPs), who claim the quality of care they can offer will be severely undermined.

The reform prompted doctors to closed their cabinets over Christmas as part of nationwide industrial action and they vowed to create a bureaucratic mess for the government.

Their main of bone of contention is health minister Marisol Touraine’s plan to bring an end to a system, known as “tiers payant”, which sees patients in France pay upfront to see a doctor, 

'A battle to save the French model'

The money handed over by patients, normally €23 for a consultation is then refunded mostly by the state's social security system and the rest by private insurance companies known as “mutuelles”.

The reform, which was an election promise of President François Hollande’s and demanded by the public will instead see doctors bill the state and private insurance companies for patients' visits.

Dr Eric Henry who will lead Sunday’s march to the Ministry of Health in Paris told The Local that France’s health service will no longer be the envy of the world if the reforms pass.

“This is a battle to save the French model. When we look at other countries we are always proud to be French because we know at the end of the day we will receive good health care here,” said Henry.

“This is the country where everyone around the world would like to receive treatment.”

The doctor leads the organisation Movement for Health for All which was created in February to bring health professionals together under one umbrella group under the slogan: “No to the health reform, united for the future of health care”.

'Doctors know their profession will be ruined'

“On Sunday we will see many doctors aged in their 50s and 60s, who are close to retirement, take to the streets in protest. They know that if it continues like this their profession will be ruined.”

Doctors say scrapping the system of paying upfront will see them lose their independence and will end up with them being “dictated to” by insurance companies who they will have to apply to for all reimbursements – basically their salaries.

Not only will it mean doctors having to spend hours filling in paperwork, but they will end up with less time with their patients and less independence to give the public the care they need.

“Having the patient pay upfront is the key to the system,” says Henry. “In France the quality of care is good because doctors are independent.

“Currently it’s not the social security system that pays me, it’s not the minister of health who pays me, it’s my patients. I am responsible for their health,” he said.

'What is the best for my patient?'

“If we change the system, it will be whichever insurance company pays me, who is responsible. The Social Security service will say to me 'Mr Henry you are prescribing too many antibiotics’, ‘you are prescribing too many pills and sending people for too many tests’ and they will tell me I have to prescribe less.

“I will no longer be free to ask the question 'what is the best thing for the patient’s health?' I will no be longer be independent.”

Henry also fears that without patients having to pay upfront they are more likely to visit the doctor “for any old reason”, which will mean he will have less consultation time with each patient.

'It will end up like in the UK,” he says.

The Movement for Health for All is hoping as many as 40,000 doctors take to the streets on Sunday to put pressure on the government, which so far has turned a deaf ear to their concerns.

“The Health Minister is not listening and that’s why we are protesting on Sunday. And we’ll continue to protest. If she pulls her plan then we’ll stop our protests, but if she doesn’t listen then we’ll continue. At the moment we are not sure what we will have to do to make sure she drops the reform.”

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France brings in free contraception for all women aged 18-25

Free birth control for all women under 25 will be available in France from Saturday, expanding a scheme targeting under-18s to ensure young women don't stop taking contraception because they cannot afford it.

France brings in free contraception for all women aged 18-25
A doctor holds an interuterine contraceptive device (IUD) before inserting it in a patient. Photo: Adek Berry/AFP

The scheme, which could benefit three million women, covers the pill, IUDs, contraceptive patches and other methods composed of steroid hormones. Contraception for minors was already free in France.

Several European countries, including Belgium, Germany, the Netherlands and Norway, make contraception free for teens. Britain makes several forms of contraception free to all.

France announced the extension to women under 25 in September, saying surveys showed a decline in the use of contraception mainly for financial reasons.

The move is part of a series of measures taken by President Emmanuel Macron’s government to boost women’s rights and alleviate youth poverty. The free provision is supported by women’s groups including the association En Avant Tous.

“Between 18 and 25-years-old, women are very vulnerable because they lose a lot of rights compared to when they were minors and are very precarious economically,” spokeswoman Louise Delavier told AFP.

Leslie Fonquerne, an expert in gender issues, said there was more to be done.

“This measure in no way resolves the imbalance in the contraceptive burden between women and men,” the sociologist said.

In some developed countries, the free contraception won by women after decades of campaigning is coming under attack again from the religious right.

In the United States, former president Barack Obama’s signature health reform, known as Obamacare, gave most people with health insurance free access to birth control.

But his successor Donald Trump scrapped the measure, allowing employers to opt out of providing contraception coverage on religious grounds — a decision upheld by the Supreme Court in 2020.

Poland’s conservative government has also heavily restricted access to emergency contraception as part of its war on birth control.