2.3 Professional organizations

Professional organizations are the next component of the health care system. At all levels of the system the two types of professional health organizations are presented. They are professional associations and trade unions. Associations are predominantly focused on the medical ethics and monitoring the practice of doctors, pharmacists and other professionals, while trade unions stand for the interests of professional groups. There is an opportunity for doctors to choose from several trade unions, even hospitals and pharmaceutical producers have their unions. (Brunner. 2009, June)

2.4 Health care users

The last component of the French HC system is its users. Patients associations developed at a significant pace. The expectations of the health care users form the demand for HC services. Thus their importance is rising. In 2002 a number of patient organizations regrouped and created a collective unit (CISS). (Rodwin, 2006. p. 160)

In the organizational structure of the health care system three main features are clearly seen. The mix of public and private HC providers is controlled by the state, which sets objectives and overall frameworks for the system and appears as the main HC actor. Costs are shared at all levels. Moreover, three basic principles are implemented in the HC organizational structure. The variety of statutory insurance schemes makes the coverage universal that denotes the principle of solidarity; according to it each citizen is able to receive coverage using one of eleven statutory schemes. The existence of patients associations means that the second principle of liberalism is maintained. Patients’ freedom of choice and rights are protected. Finally, the principle of pluralism shows up in the diversity of the HC organizations and associations at all levels. These features and principles define the organizational structure of the HC system and at the same time they limit it. The presence of all features and principles make the structure firm and stable.

3. The management of the health care system

3.1 Resource planning

To be efficient the health care system should be regulated and managed by different acts and laws. In France it is done by a strict regulating act, which is called Numerus clausus. This act is regulating human resources on different levels – from a city level to a national level. It is applied in order to reduce inequality in the distribution of doctors in particular areas. With the help of this act during the last thirty years regional disparities have slightly decreased. Also this act helped to increase the number of doctors in areas, in which there was a lack of specialists, for example anesthesiology, intensive care, gynecology and obstetrics and pediatrics. However, Numerus clausus does not allow self-employed doctors to work in particular areas, whereas hospital work is dependent on posts offered by institutions. Numerus clausus also regulates the number of people studying for such professions as nurses, physiotherapists, etc. (Sandier et al., 2004. pp. 28-29).

Another part of the health system regulation is the management of material recourses. Until 2003 material planning involved the combination of two tools: quantitative and qualitative.

The first one was a medical map – a quantitative tool, which divided each region into health care and psychiatric sectors. Each sector should have had at least 200 000 inhabitants, and it could have less if the sector consisted of an entire department. Within a sector or a group of sectors, the director of ARH (Agence Régionale de l’Hospitalisation, Regional Hospital Agency) decides on different quantitative norms. It is very important that the medical map has also taken into consideration the number of private clinics and hospitals. Moreover, the medical map counted expensive and rare medical equipment, such as dialysis apparatus, radiotherapy equipment, magnetic resonance imaging, scanners and lithotripters. (Green et al., 2001, p. 45)

For the past years, the authorization from the Ministry of Health is also required for certain very specialized types of care, such as organ transplantation, the treatment of major burns and etc. This fact indicates a change from quantitative management to a qualitative management approach. Since 2003 the second tool – the Regional Strategic Health Plan (SROS), has become a main tool in the system regulation. The main focuses of SROS are emergency care, perinatal care and cancer. This specialization has dictated modern trends of development. In other words – this plan is setting a point on providing comprehensive range of care in most hospitals, while some individual hospitals will be responsible for more or less serious cases. Apart from these three areas, which are available in all regions, each region is specified in certain issues, such as follow-up care and rehabilitation, palliative care, suicide, cardiovascular diseases and etc. The SROS also provides frameworks for granting authorizations, approving proposals submitted by institutions and negotiating contracts with public, private non-profit or private for-profit hospitals. (Rodwin, 2006. pp. 161-163)