A new fund called National Solidarity Fund for Autonomy (CNSA, Caisse Nationale de Solidarité pour l'Autonomie)
is created in 2005 in order to provide co-ordinated and timely care to the elderly people who lost autonomy, or people
with acute dependence in general. In order to finance this new fund, the Senate passed a law imposing one extra day
of work a year for the employees. The public holiday of Pentecote turned into a working day for all.
Introduced in France by the Social Security Funding Act, in 2003, reference prices, named TFR (tarifs forfaitaires
de responsabilité) aim to encourage the development and use of generic drugs and to reduce pharmaceutical
expenditure. The policy introduces a reference price for each generic group based on the average prices of the generics
in the same group in French market. This reference price serves as the basis for the reimbursement by the health
Hospital pharmacies can deliver certain drugs to ambulatory patients (retrocession in French). Some drugs can only
be used in hospitals but nevertheless be accessed by ambulatory patients through hospital pharmacies. In this case,
hospitals are refunded by health insurance funds for the purchase of the drugs. A new legislation is introduced in
December 2004 in order to control these proceedings. A list is set to limit drugs which can be accessed by ambulatory
The main objective of this policy is to improve the availability and quality of public data on the demographics of health professionals. Other objectives are to track inequalities in the distribution of medical work force, to estimate the future
needs and to make recommendations. Medical manpower deprived areas will benefit from financial incentives to retain
health professionals. The Government also experiment the possibility of delegating certain medical tasks from physicians
The French government decided in 2005 to introduce a psychiatric and mental health care plan for the period 2005-2008
with four aims: 1) to improve the mental care supply; 2) to improve the involvement of patients, their families and health professionals in policy decisions concerning mental health care and to address challenges linked to stigma and discrimination; 3)to improve quality of care and research in this area; 4) to implement programs for specific disorders or population groups.
The evaluation of professionals' practices (EPP) is a form of medical audit. It aims to improve the quality of care by giving
to doctors a peer's feed back on their patterns of practice. It was first set up by law in December 1999 as a voluntary
process for doctors working on a private practice in the ambulatory care sector.
The health insurance reforms of august 2004 was a major turn in the development of EPP. It made it compulsory to every doctors.
The French government is introducing a new case-mix based prospective payment system for all providers with
an aim to improve efficiency and harmonise prices and payment methods between the public and private sectors.
A new agreement has been concluded in January 2005 between the physician unions and the newly created Union
of sickness funds, the first one since 1996 for the specialists. It concretises the principles of “co-ordination of care”
put forward by the Health Insurance Reform Act.
The French government and the Sickness Fund are introducing a new nomenclature of medical and technical procedures
and services with the following general aims: to describe more precisely medical and technical procedures and services
on a common basis both for hospital and ambulatory care; to recast the fee structure between specialists in private practice based on a nomenclature that is consistent and without financially adverse incentives.
In France a new Public Health Act was adopted in August 2004 with an aim to reshape public health policy. However,
its slow implementation until now seems to compromise the achievement of its goals.