A non-French observer would probably be astonished that doctors in France regularly participate in the national sport of going on strike even though their health system, according to the World Health Organisation, is supposed to be one of the best in the world.
Although France spends about 9.5% of its GDP on health care,1 which means that it is among the top of the OECD nations, the public health insurance deficit is currently at €12.9 billion.2 This chronic deficit is the result of the difference between the contributions taken from salaries on the one hand, and expenditure on hospital and ambulatory health care on the other. There is no cap on expenditure and therefore there is no waiting list.
Despite the fact that a budget is voted every year by the Parliament, expenditure has always exceeded the amount fixed. Hospitals, too, have a fixed annual budget, but public authorities often have no choice but to inject more money during the fiscal year, especially when the media are scandalised by stories of overwhelmed emergency services, or the mismanagement of last summer's heatwave, which caused an increase of about 15 000 deaths among the aged and the infirm.
Expenditure in private practice is also unregulated, apart from the fixing of rates to be charged for medical services by the public authorities. Unfortunately rates are set at levels below their real economic value. For example, a consultation with a GP is fixed at €20. The result is an inflation in the number of consultations in ambulatory care and an overloaded timetable, in order to compensate for the meagre rate. According to the French Ministry of Health, on average, GPs work 56 hours per week for a income of €73 500.3 This trend of always going after more does not help to contribute to the quality of services for patients.
In private practice, as well as in hospitals, the number of doctors has never been as high as at present. The problem lies in the lack of supporting staff (paramedics, medical secretaries) and the relentless increase in bureaucracy and paperwork — for the average French GP at least 2 or 3 hours per day.
Doctors are disillusioned, with large numbers contemplating early retirement or changing professions.
- © British Journal of General Practice, 2004.