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Chapter 3 | The impact of the crisis on the health system and health in France
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All these elements illustrate the structural shortcomings hindering reforms as
well as recent developments representing incremental change. While this sheds
light on how the health system response to the crisis was more muted than it
could have been, it is interesting to note major measures that were not taken
because of the crisis. This was the case for the long-discussed and announced
reform of long-term care financing. Despite the major challenge that long-term
care represents and despite the fact that several concrete reform options were
repeatedly debated (Chevreul & Berg Brigham, 2013), the Ministry of Health
decided, in light of the crisis, not to initiate major long-term care financing
reform. It must be wondered whether, in this case, the crisis represented an
opportunity not to address a highly controversial policy issue.
While this suggests that the crisis itself, on the one hand, represents a barrier
to change, on the other hand, it may also be argued that it constitutes an
opportunity for health reform. Indeed, one of the impacts of the crisis may
be that long-standing issues affecting the French health system and some of
the proposed solutions dating to the pre-crisis period seem to be receiving
increasing attention in civil society. For example, the 2013 National Health
Conference 13 has published a memorandum on "how to exit the crisis stronger
than before" (Conférence nationale de santé, 2013) in which, among others,
the following recommendations were made:
• do whatever possible not to worsen health inequalities without abandoning
the perspective of reducing them;
• before any decision, make use of analyses of added value and improvement
in the relative medical benefit; and
• link financing solidarity with solidarity of care practice.
Hence, although these points were well acknowledged by actors inside an "inner
circle" before the crisis, they seem to be increasingly recognized in a wider arena.
This may indicate that efforts for system reform are gaining momentum, albeit
at a slow pace. Indeed, in September 2013, the Ministry of Health launched
the National Health Strategy (stratégie nationale de santé). It aims to reshape
the French health system from 2014 onwards, and is centred on three domains:
(1) prevention and information, (2) health care system organization, and (3)
patient rights. In its current phase, nationwide stakeholder consultations are
organized by the regional health care agencies (Ministry of Work, Employment
and Health, 2014). Although the National Health Strategy is not, as such,
a response to the crisis, it is in part based on the recommendations of the
National Health Conference and may be interpreted as using the window of
opportunity opened by the economic downturn.
13 The National Health Conference (Conférence nationale de santé) was created as a permanent body by the 2004 Public
Health Act; it brings together representatives of the health professions, health care facilities, regional health conferences
and a number of additional experts to discuss and define health care priorities at the national level.