France

The provision and health financing is based on Regional Health Plans. Health insurance funds are, by law, private organisations charged with the provision of a public service, but because their close supervision by government they are in effect non-governmental quasi-public organisations. Public hospitals are also independent, but controlled by the local government and managed by the professional administrators, not physicians. Hospital care is available in public non-profit and in private for profit hospitals. The choice of a physician or a hospital depends on the patients individual preferences and patients can call a GP or a specialist in private or in public system. Outpatient care is generally provided in doctor's offices or sometimes at the home of the patient

The health insurance law and health financing are part of the Social Security scheme which derives its earmarked resources from compulsory contributions from insured persons and their employers. For an employee the contribution rate is rather high (19.4%). There exist 6 different health insurance funds, which finance about 70 per cent of all health care. Funds are mainly organised according to the occupational groups. The national social security budget for public hospitals is approved in the Parliament. Distribution of funds between hospitals is managed by the Regional Hospital Agencies.

Patient pays first all the outpatient care and will be reimbursed later by the insurance fund (and often also by the complementary insurance). In hospitals the patient do not have to pay the treatment but they has to pay a small fixed daily price for hospital accommodation and meals. After 30 days there is no out-of-pocket liability in in-patient care. In private hospitals, which take part in the public health service delivery, the some medical treatment charges are added into the fees. Prescribed pharmaceuticals have a co-insurance but over the counter drugs the patient must pay.

The payer of health care varies according to the nature of the service and its provider. In 1996 Social Security (i.e. national health insurance system) financed 74% of the all care provided, complementary private insurance 12% and the patients 14%. Private GP s incomes are based on fee-for-service financing and in public health centres on salaries. They do not have any gate-keeping tasks. All hospitals gets their incomes based on the care provided (GHM, French version of DRG) from 2004 onwards.

Investments are the subject to the regional approval. Sources for investments are both the state subsidies and loans from the sickens insurance funds. This type of financing is, however, decreasing and investments are financed trough infernal sources based on deprecations. Public hospitals can decide investments independently, if they have money from internal sources, but according to the Ministry's plan. The additional amount of money to the university teaching hospitals is about 20% from annual recurrent expenditures.