France: Contemporary Problems and Future Scenarios

The French health system is characterized by three distinguishing features: a strong central state; a quasi-public national health insurance (NHI) system; and a powerful medical profession that has tenaciously demanded respect for four principles: free choice of the physician by the patient; freedom of prescription by the doctor; mutual agreement by the physician and patient on the price of services; and fee-for-service payment. Since the Medical Charter of 1927, when these principles were first promulgated, they have been widely accepted even though they are often violated in practice. The organization of health care in France rests on an uneasy truce,