Why do we need a European Forum for Primary Health care ? Is France concerned ?

1. Why do we need a European Forum for Primary Health care ? Is France concerned ? Marianne Samuelson Kos-Grece 2005 Pr M.Samuelson

2. French Health care systemMain features • Fee for service payment • GPs have no real gate keeping function and there is no regulation of the circulation of patients within the system • Unequal distribution of GPs throughout the country • Most specialists are in private practices in ambulatory care • A very complex health insurance system Pr M.Samuelson

3. French context • Social changes • Medical demography • Workload acceptance • Consumers/citizens demands for transparency/quality • Healthcare system changes • Not a Primary Health Care centred system • Quality proposed as a regulation instrument Pr M.Samuelson

4. System organised for acute episodes of care • System centred on acute episodes • Patient role not emphasised • Follow up sporadic and not organised • Prevention is neglected Pr M.Samuelson

5. Strong UK Denmark Spain The Netherlands Italy Finland Weak Portugal Belgium Greece Germany France European countries with strong and weak primary care systems Pr M.Samuelson

6. Primary Care Scores, 1980s and 1990s 1980s 1990s Belgium 0.8 0.4 France - 0.3 Germany 0.5 0.4 United States 0.2 0.4 Australia 1.1 1.1 Canada 1.2 1.2 Japan - 0.8 Sweden 1.2 0.9 Denmark 1.5 1.7 Finland 1.5 1.5 Netherlands 1.5 1.5 Spain - 1.4 United Kingdom 1.7 1.9 Starfield 1998 Pr M.Samuelson

7. Primary Care Score vs. Health Care Expenditures, 1997 (B. Starfield 2000) UK DK NTH FIN SP CAN AUS SWE JAP GER US BEL FR Pr M.Samuelson

8. Average Rankings* for Health Indicators in Infancy, for Countries Grouped by Primary Care Orientation Low Birth Neonatal Postneonatal Infant Weight Mortality Mortality Mortality (1993) (1993) (1993) (1996) Lowest 9.5 7.8 11.5 8.8 (Belgium, France Germany, US) Middle 7.3 5.3 5.5 6.0 (Australia, Canada, Japan,Sweden) Highest 4.8 7.8 4.6 6.4 (Denmark, Finland, Netherlands, Spain, UK**) *Best level of health indicator is ranked 1; worst is ranked 13, thus, lower average ranks indicate better performance. **England and Wales only Pr M.Samuelson Starfield 1999

9. Why was France ranked first by WHO in 2000 • Availability of supply of providers • High degree of freedom for physicians and patients • Few restriction in the range of services covered by the heatlth insurance system • Easy access • Absence of waiting list • Patient satisfaction Pr M.Samuelson

10. European challenges / French context • Aging population • Chronic diseases • Cultural and ethnical diversity • Scientific progress • Patient involvement • Tasks division among health care providers Pr M.Samuelson

11. Two questions • Is it still possible to maintain the ideal synthesis of solidarity, liberalism, and pluralism ? Claude Le pen N Engl J Med November 2004 • Is French health care system adapted to face the future European challenges Pr M.Samuelson

12. A turning point :last opportunity for a model or decline… Pr Marianne Samuelson

13. Why could France benefit from the European forum for primary care • Connect Primary health care providers of different professions • Connect providers, researchers , policymakers from different European countries • Promote communication with policymakers at a local national and European level to create a common vision • Benefit from monitoring policies on their relevance to primary care. ……….. France has a lot to gain ! Pr M.Samuelson