Why France is planning a massive overhaul of its healthcare system

French President Emmanuel Macron will on Monday present the first part of the government’s plan to reorganise France’s much-vaunted healthcare system.

Why France is planning a massive overhaul of its healthcare system
French hospital workers have long been protesting to achieve higher salaries and better working conditions. Photo: AFP

The stage is set for the launch of the beginning of what French media has described as “perhaps the most important moment” of Macron's presidency.

This is the opening of a seven-week long consultation with healthcare professionals, which will form the backbone of a major overhaul of France's hospital and community health system.

“We will act fast, we will act strongly,” health minister Olivier Véran said as he announced that the government would enter this process in an attempt to meet hospital staff who have long been protesting about low pay and poor working conditions, problems exacerbated by the coronavirus crisis.

Among the most pressing topics to be discussed during the Ségur de la santé – the name of the process has been taken from the avenue de Ségur, the street in Paris where the health ministry is located – are salaries, working conditions and general organisation of healthcare services in cities and rural areas.

For the first time since Macron entered the Elysée Palace all of these topics will be on the table, after the president himself admitted that the government made a “strategic error” when pushing forward the 2018 health plan, which aimed to continue a longstanding process of rendering hospitals more efficient.

“We will shake up corporatism, habits, inertia. We will be transgressive if necessary,” said former neurologist Véran, promising that “nothing will be the same.”

The government's plan to redefine the health system contains four pillars;

  • Reevaluating salaries
  • Defining an investment plan to reform the way hospitals are currently financed
  • Rendering the system more flexible and simple
  • Rethinking the organisation between city and rural area and doctors and hospitals

The results of the Ségur de la santé will be part of a new social security law that will be presented to the parliament this autumn.

French Health Minister Olivier Véran has promised a shake-up of the current health system. Photo: AFP 

Salary increase

Although the French hospital system is regarded as one of the most generous and best in the world for patients, nurses in France are currently among the worst paid in Europe and they have been protesting about their low wages for years.

The government’s coronavirus bonus (€500 for most staff, €1,000 for some), fell victim to harsh criticism by most of the country’s hospital sector and hospitals are now asking for €300 more per nurse a month – 200,000 nurses in total – along with an 20-30 percent salary increase for doctors.

Union representatives have said they remain convinced that the government will meet their demands of a general salary increase, and government officials themselves have over the past week on several occasions indicated to French media that such a raise is indeed on the books.

READ MORE: How do nurses' salaries in France compare to the rest of Europe?

Working hours

Changing the rules on the number of hours nurses and other hospital staff work will be a main point of disagreement between unions and the government in the coming weeks.

In an interview with the French newspaper Journal du Dimanche, Véran said he wanted to “render more flexible” the rules regulating working-hours, to make it easier “for those who wish to” to work longer.

Some argue that French nurses earn less because their 35-hour week is shorter than those of for example their German colleagues.

Unions slam this as inaccurate, and say that French nurses are obliged to take extra shifts to top up their too-low salaries, and that increasing their hours would only worsen the existing situation.

“We need to create more jobs in order for everyone to be able to take the days off that they have the right to take, as they, right now, often can't,” said Thierry Amouroux, union spokesperson for SNPI, to Les Obs.

They are asking for 20,000 new hospital posts.

Could the coronavirus crisis be the turning point nurses have waited years to achieve? Photo: AFP

Reorganising the system

In November French government spokesman Sibeth Ndiaye told members of Anglo American Press Association including The Local, that while she had sympathy for medics who at the time were taking industrial action, she believed this was not the way to go about raising questions about the French health service.
She said: “President Macron does not want to make small changes and put small amounts of extra money into the system, but instead we need systemic reform.”
The government's current plan will include a review of the organisation to improve and strengthen decentralised health services, evaluating steps that can be taken to prevent illness rather than just treating the disease.
Not new
For decades, French governments have, along with governments across the developed world, striven to rid themselves of healthcare costs by turning hospitals into more profitable, more efficient businesses, favouring short-term services over costly long-term care.

Hospital workers in France have been organising street protests for months to get the government's attention.

In the winter of 2019, barely three months before the coronavirus stretched many hospitals virtually to breaking point, nearly half of France’s public hospital services were on strike (a largely symbolic label as actual walk-outs in the public hospital sector are forbidden by the law).

“Public hospitals are collapsing,” read a joint statement published in November in Le Monde newspaper by 70 public health chiefs from Paris hospitals who feared the crisis was reaching an “irreversible breaking point”. 

In January, over 1,200 health officials resigned from their administrative duties in protest.

The coronavirus pandemic – by forcing the government to slam down a strict, nationwide lockdown in order to save hospitals in hot-spots from buckling under the mounting pressure – gave staff the attention they have been craving for years.
Now they are hoping for “a substantial gesture” from the government as compensation. As Le Monde stated in their editorial on Monday, “the anger is so big that he (the president) is no longer entitled to mistakes.”

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What changes in France in July 2022

Summer's here and the time is right for national celebrations, traffic jams, strikes, Paris beaches, and ... changing the rules for new boilers.

What changes in France in July 2022

Summer holidays

The holiday season in France officially begins on Thursday, July 7th, as this is the date when school’s out for the summer. The weekend immediately after the end of the school year is expected to be a busy one on the roads and the railways as families start heading off on vacation.

READ ALSO 8 things to know about driving in France this summer


But it wouldn’t really be summer in France without a few strikes – airport employees at Paris’ Charles de Gaulle and Orly airports will walk out on July 1st, while SNCF rail staff will strike on July 6th. Meanwhile Ryanair employees at Paris, Marseille and Toulouse airports will strike on yet-to-be-confirmed dates in July.

READ ALSO How strikes and staff shortages will affect summer in France

Parliamentary fireworks?

Prime minister Elisabeth Borne will present the government’s new programme in parliament on July 5th – this is expected to be a tricky day for the Macron government, not only does it not have the parliamentary majority that it needs to pass legislation like the new package of financial aid to help householders deal with the cost-of-living crisis, but opposition parties have indicated that they will table a motion of no confidence against Borne.

Parliament usually breaks for the summer at the end of July, but a special extended session to allow legislation to be passed means that MPs won’t get to go on holiday until at least August 9th. 

Fête nationale

July 14th is a public holiday in France, commemorating the storming of the Bastille which was the symbolic start of the French Revolution. As usual, towns and cities will host parades and fireworks – with the biggest military parade taking place on the Champs-Elysées in Paris – and many stores will remain closed.

As the national holiday falls on a Thursday this year, many French workers will take the opportunity to faire le pont.

Festival season really kicks in

You know summer’s here when France gets festival fever, with events in towns and cities across the country. You can find our pick of the summer celebrations here.

Paris Plages

The capital’s popular urban beaches return on July 9th on the banks of the Seine and beside the Bassin de la Villette in northern Paris, bringing taste of the seaside to the capital with swimming spots, desk chairs, beach games and entertainment.  

Summer sales end 

Summer sales across most of the country end on July 19th – unless you live in Alpes-Maritimes, when they run from July 6th to August 2nd, or the island of Corsica (July 13th to August 9th).

Tour de France

The Tour de France cycle race sets off on July 1st from Copenhagen and finishes up on the Champs-Elysée in Paris on July 24th.

New boilers

From July 1st, 2022, new equipment installed for heating or hot water in residential or professional buildings, must comply with a greenhouse gas emissions ceiling of 300 gCO2eq/KWh PCI. 

That’s a technical way of saying oil or coal-fired boilers can no longer be installed. Nor can any other type of boiler that exceeds the ceiling.

As per a decree published in the Journal Officiel in January, existing appliances can continue to be used, maintained and repaired, but financial aid of up to €11,000 is planned to encourage their replacement. 

Bike helmets

New standards for motorbike helmets come into effect from July 1st. Riders do not need to change their current helmets, but the “ECE 22.05” standard can no longer be issued – and all helmets sold must adhere to a new, more stringent “ECE 22.06” standards from July 2024

New cars

From July 6th new car models must be equipped with a black box that record driving parameters such as speed, acceleration or braking phases, wearing (or not) of a seat belt, indicator use, the force of the collision or engine speed, in case of accidents.

New cars II

From July 1st, the ecological bonus for anyone who buys an electric vehicle drops by €1,000, while rechargeable hybrids will be excluded from the aid system, “which will be reserved for electric vehicles whose CO2 emission rate is less than or equal to 20g/km”.

What’s in a name?

Historically, the French have been quite restrictive on the use of family names – remember the concern over the use of birth names on Covid vaccine documents? – but it becomes easier for an adult to choose to bear the name of his mother, his father, or both by a simple declaration to the civil status. All you have to do is declare your choice by form at the town hall of your home or place of birth.

Eco loans

In concert with the new boiler rules, a zero-interest loan of up to €30,000 to finance energy-saving renovations can be combined with MaPrimeRénov’, a subsidy for financing the same work, under certain conditions, from July 1st.

Rent rules

Non-professional private landlords advertising properties for rent must, from July 1st, include specific information about the property on the ad, including the size of the property in square metres, the area of town in which the property is in, the monthly rent and any supplements, whether the property is in a rent-control area, and the security deposit required. Further information, including the full list of requirements for any ad, is available here.

Perfume ban

More perfumes are to be added to a banned list for products used by children, such as soap-making kits, cosmetic sets, shampoos, or sweet-making games, or toys that have an aroma.

Atranol, chloroatranol (extracts of oak moss containing tannins), and methyl carbonate heptin, which smells like violets, will be banned from July 5th, because of their possible allergenic effects.

Furthermore, 71 new allergenic fragrances – including camphor, menthol, vanilin, eucalyptus spp. leaf oil, rose flower oil, lavendula officinalis, turpentine – will be added to the list of ingredients that must be clearly indicated on a toy or on an attached label.

Ticket resto limits

The increased ticket resto limit ended on June 30th, so from July 1st employees who receive the restaurant vouchers will once again be limited to spending €19 per day in restaurants, cafés and bars. The limit was increased to €38 during the pandemic, when workers were working from home.