2. The organizational structure of the health care system

French health care system includes four major components, which are the state, statutory health insurance funds, professional organizations and health care consumers.

2.1 The state

The role of the state, the first component of the system, is primary the control and setting objectives for HC system. The authority is divided between the parliament and the government, in particular the Ministry of Health.

Annually the parliament passes the Act on Social Security (further the Act), which is based on the reports of the Accounts Commission and the National Health Conference. This act regulates the future budget spending and contains some new rules and regulations concerning policy for social security, health care and benefits. For example, it sets prices for medical procedures, divides the budget expenditure between the different sectors, defines the priorities for the national programs. Moreover, the Act provides the report on social security and health care policy trends.

While the role of the parliament is passing the Act, the Ministry of Health (further the Ministry) is generally responsible for HC management, which requires much more effort due to its scale. After the last reorganization the Ministry conists of four structures, which are called directorates. A general directorate is in charge of health policy. The second directorate of hospitals is responsible for resources management. Financial matters are regulated by a directorate of social security, which also manages some social security organizations. Finally, social aspects of health care are regulated by a general directorate for social policy. Additionally, the Ministry has local services for regions and even departments. As Simone Sandier, a research director at the Centre de Recherche, d'Etudes et de Documentation en Economie de la Sante (CREDES) in Paris and an elected member of the (U.S.) Institute of Medicine, has noted, “The Ministry of Health controls a large part of the regulation of health care expenditure, on the basis of the overall framework established by parliament” (2004. p. 20).

One more tool that the state uses for the control of HC system is agencies and committees within the administration. There are nine of them and each has a specific focus. The most valuable for the state are the High Level Committee on Public Health, the National Committee on Medical Safety, the National Agency for Accreditation and Evaluation of Health Care and the Economic Committee for Medical Products.

2.2 Statutory health insurance funds

The second component of the health care system is statutory health insurance funds. At national level it is the National Fund for the Insurance of Salaried Employees (CNAMTS). There are 16 regional funds and more than 100 at local level. These funds provide universal health coverage in the country. (The Commonwealth Fund, 2010, June, p. 23)

There are eleven insurance schemes. Three major schemes are: the general, the agricultural and the one for non-agricultural self-employed people. The proportion of coverage is as follows: the general scheme covers about 84% of population, the agricultural scheme – about 7,2% and the scheme for non-agricultural self-employed people provides health insurance to about 5% of French population. Thus 3,8 % are covered by other specific schemes (OECD Health Data, 2010).

The statutory HC system in France has three levels. The first one is the national level, where the whole policy for the sector is formed, discussed and approved. At this level the parliament, the Ministry of Health and other governmental organizations play a crucial role.

The second level, on which the health policy is actually implemented, is the regional level. Each institution at this level has its own specific area of activity. Public and private hospital planning and financial resources management are done by the regional hospital agencies (ARH). Three main insurance schemes at this level are coordinated by the regional unions of the health insurance funds (URCAMs). Finally, various procedures as the analyses of the work of different segments of health care system, studying the demand for HC services and coordinating the work of doctors are performed by the regional unions of self-employed doctors (URMLs). Annually, the regional health conferences are held for institutions, heath care users and professionals. Reports from these meetings are sent to the national ones.

The third level of statutory health care is the department one, at which health and social services are managed by the general councils. The term ‘general council’ refers to an elected body funded through local taxes and subsidies from the central ones.