For members


The 7 numbers that explain the French hospital crisis

Emergency workers in France are involved in ongoing industrial action over what they say is a "crisis" in the hospital system - here are seven statistics that help explain the problems.

The 7 numbers that explain the French hospital crisis
All photos: AFP

The French healthcare system has a reputation as one of the best in the world – and readers of The Local  have rushed to praise the system for its great standards of care.

READ ALSO 'Excellent, caring, efficient': In praise of beleaguered French hospitals

But an ageing population and the rise in the number of people living with chronic conditions has put a strain on the system to the extend that emergency room medics staged a protest march last week against what they describe as a system at “breaking point”.

So what are the problems?

1. Emergency room visits have doubled in 20 years

This is the big one – the increasing strain on the service. In 2016 private and public emergency facilities in France received a total of 21 million visits, compared to 10.1 million in 1996.

In common with the rest of Europe, France's population is ageing and that means more people living with chronic conditions. The case in lifestyle-related chronic conditions such as diabetes is also a factor and due to shortages in community-based care, many of these people end up in emergency departments. 

It's why the French government wants to undertake a major reorganisation of the health service to provide a lot more care in the community, and stop people ending up in hospital. But that will not be a quick or simple process.

2. There are 80,000 fewer hospital beds than there were 15 years ago

And yet as the number of hospital visits increases, the number of beds that people can be admitted to is falling, leaving more and more people stuck in emergency departments.

In 2017 there were 399,865 hospital beds in total in France, compared to 468,418 in 2003.

Of course part of that can be accounted for in the rise of treatments like keyhole surgery, which means that patients need to spend much less time in hospital, and the system has also created 75,000 'day beds' for people having treatment who do not need an overnight stay, but doctors say it still leaves them struggling to find beds for everyone who needs them.

According to the World Bank, France had 6.5 hospital beds per 1,000 people in 2013. This is less than in Germany (8.3), Austria (7.6) or Hungary (7), but much more than in the United Kingdom (2.8), Spain (3) or Portugal (3.4).

3. A fall in hospital income

The rise in day surgery and treatments is good news for patients who don't fancy a long stay in hospital, but has left hospitals with a drop in income that they are struggling to cope with.

The French system means that instead of being given a lump sum annual budget by the government, hospitals charge patients for the procedure and the government then reimburses the patient. Charges for an overnight stay are obviously higher than for a day procedure, and the difference in cost has left hospitals out of pocket – even allowing for less need for night nursing staff.

This is one of the factors that has left many of them struggling with debt. In 2017, the debt of the 1,000 public hospitals represented more than €30 billion, or 42.8 percent of their turnover.
“This debt has increased significantly since the early 2000s, which is explained by the search for continued investment in a context of declining hospital resources, and on the other hand by national investment plans,” explains the Fédération hospitalière de France, in franceinfo.
And this debt weighs heavily on the finances of these institutions. Each year, hospitals pay about €840 million in interest costs on the debt.
4. Low pay for nurses

As well as feeling the pressure of a struggling system, nurses in France are not well paid and a salary increase is among the major demands of striking medics.

According to the OECD, the average nurse's salary was slightly lower than the average salary in France (€2,225 a month after tax), while in Spain nurses earn 1.27 times the average wage and in Mexico 1.79 times. In the UK the average nurse earns roughly five thousands pounds a year less than the average salary.

5. Violence against medical staff

In 2018 the National Observatory of Violence in the Health Environment recorded 20,330 reports of violence against medical staff, with psychiatric and emergency services taking the brunt.

6. High levels of sick leave

Perhaps unsurprisingly given the above, absences for sick leave are also high among medical staff – an average of 10 sick days per year, compared to a private sector average of 7.9 days. Nurses and orderlies have the highest sick rates, which of course then adds to the pressure on other staff.

Mental health problems like depression and burnout are common among medical staff, and the suicide rate is 2.5 times higher than in other professions. According to a 2017 study, as many as a quarter of French medical staff have struggled with suicidal thoughts. 

7. Shortage of doctors

Many hospitals in France are reporting difficulty in finding and retaining staff, particularly doctors. This is not a problem just confined to hospital doctors, there are many areas of France, particularly rural areas but also some suburbs, classed as “medical desserts” because of the shortage of general practitioners. A survey by the  Fédération hospitalière de France reported that almost all hospitals which responded had found it difficult to fill vacant posts.

READ ALSO Medical desserts: Why one in three French towns do not have enough doctors

Data comes from Direction de la recherche, des études, de l'évaluation et des statistiques (DREES) and French government statisticians INSEE and was compiled by French news site FranceInfo.



Member comments

Log in here to leave a comment.
Become a Member to leave a comment.


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.