Steering from bismarck to beveridge: the french experience

Abstract

Objective: To describe the roots of the French Health Care System. Data synthesis: Actually, three dynamics are hidden behind the word crisis. The first dynamic was already there from the start, while the second is the result of an internal dynamic and a third dynamic can be seen as the consequence of external causes. The main recent policies are made of a mix of constraints and incentives. Most of them improve the governance of the health care system. Adaptive as well as innovative, a pragmatic attitude has been applied through compromises. Four features of which can be found: To improve the division of labor amid professionals; to move towards Beveridge like Welfare State model, giving to the central State more power; to enhance expertise through Evidence Based Medicine; to open the internal and external frontiers of the health care system. Conclusion: Those changes were mainly pulled by the moving context rather than pushed by an ideology. Therefore, since its birth, the French health care system evolves more on a muddling through like move than according to a plan given in advance. This happened to be a rather good way to avoid the worst: marketization.

The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

“…In the UK, the influence of Beveridge's vision for the National Health System continues to resonate in current days ( 21 ). Nevertheless, as Kutzin argued convincingly a decade ago already, the distinctions between European health systems are becoming less important as financing models align, driven by aging populations and growing expectations for care so that government funding fills more and more gaps in traditional social health insurance, while competition is increasingly common in national health insurance systems to manage costs ( 22 – 24 ).…”

Centralization of health policy decisions, conversion to austerity, and public defiance in contemporary France

“…Were there any French idiosyncrasies? The NPM toolbox emphasized Evidence-Based Medicine, contractual incentives (e.g., pay for performance, premiums, and penalties for care providers) as well as quantification of outputs via activity-based payment while carefully avoiding Anglo-Saxon marketization (Mossé, 2018)…”

“…In retrospect, it appears that rising economic uncertainties and a growing budget deficit triggered a streamlining of policy decisions in healthcare. The health system subsequently moved toward a Beveridge like Welfare State model that strengthened the central State (Mossé, 2018) at the expense of regions. The emphasis was placed on the standardization of accounting via the adoption of a national DRG scale and a re‐centralization of the health system in a bid to restore fiscal discipline.…”

Differentiation in Healthcare Financing in EU Countries

“…Wealthy people do not participate in this insurance system, so they are directed to private entities in the case of illness. This model is used in Germany, Austria, Belgium, the Netherlands and France [35][36][37]. The residual model involves releasing the state from the obligation to provide citizens with access to health services.…”