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Web-economic-crisis-health-systems-and-health-web Web-economic-crisis-health-systems-and-health-web
Chapter 3 | The impact of the crisis on the health system and health in France 97 6. Conclusions The financial and economic crisis originating in 2008 has had a multifaceted impact on health and the health care system in France. In terms of immediate effects on perceived health, these appeared to be limited, as reflected in consistently high self-rated health. Nonetheless, other emerging trends, such as the increase in the suicide rate for men, may be exacerbated by the crisis. In terms of the changes to the health system following the onset of the crisis, they did not implicate a different set of actors from the pre-crisis period nor did they result from any direct influence or pressure from outside the country. Instead, the actions taken were a continuation of the incremental cost-containment measures undertaken since the late 1990s. Most importantly, these measures include a decrease in scope and depth of SHI coverage and an increase in the role of user charges and VHI, as well as supply-side measures, such as drug price reductions. With regard to the midterm impact on the determinants of health, there has been a steady increase in unemployment and household debt, while personal health budgets are decreasing. The most important and burdensome element appears to be the exacerbating effect of the crisis on health and social inequalities, as indicated, for example, by an increasing percentage of people with low income forgoing care. In a context in which it may be anticipated that the full impact of the crisis still lies ahead, the need to rapidly address the issue of equitable health financing is apparent. This is particularly urgent given the increase of private health expenditure and its impact on people with low incomes and high health needs at a time where the macroeconomic figures (February 2014) show that unemployment is still on the rise. Although there are signs indicating that the move for significant reform is gaining momentum, it remains to be seen whether the government will be able to strike the right balance between equity and cost-containment efforts. References Banque du Crédit Municipal de Paris (2008). Financez vos projets. Prêt Santé. Paris, Crédit Municipal de Paris (http://www.cmpbanque.fr/pret-sante, accessed 5 March 2015). Caisses autonome de retraite des médecines de France (2012). Bénéfices non commerciaux (BNC) des médecins libéraux 2010: deuxième année de baisse pour les généralistes! Paris, Caisses autonome de retraite des médecines de France (http://www.carmf.fr/chiffrescles/stats/2012/bnc2010.htm, accessed 5 March 2015).
98 Economic crisis, health systems and health in Europe: country experience Caisse nationale de l'assurance maladie des travailleurs salaries (2013). Avenant No. 2 à la convention nationale. Paris, Caisse nationale de l'assurance maladie des travailleurs salaries (http://www.ameli.fr/professionnels-de-sante/pharmaciens/votreconvention/convention-nationale-titulaires-d-officine/avenant-n-2-a-la-conventionnationale.php; accessed 5 March 2015). Calvet L et al. (2013). Santé bucco-dentaire des enfants: des inégalités dès le plus jeune âge. Paris, Ministère des Affaires sociales, de la Santé et des Droits des femmes (DREES Studies and Results No. 847) (http://www.drees.sante.gouv.fr/sante-buccodentaire-des-enfants-des-inegalites-des-le-plus,11172.html, accessed 5 March 2015). Caniard É, Meyer C (2012). Les complémentaires et la crise?: menace ou opportunité? Les Tribunes de la Santé, 36(3):55–66. Chang S-S et al. (2013). Impact of 2008 global economic crisis on suicide: time trend study in 54 countries. BMJ, 347:f5239. Charpin J-M, Tlili C (2011). Perspectives démographiques et financières de la dépendance. Paris, Ministère des Affaires sociales, de la Santé et des Droits des femmes (http://www.social-sante.gouv.fr/IMG/pdf/rapport_g2_def-2.pdf; accessed 5 March 2015). Chevreul K, Berg Brigham K (2013). Financing long-term care for frail elderly in France: the ghost reform. Health Policy, 111(3):213–220. Chevreul K et al. (2010). France: health system review. Health Systems in Transition, 12(6):1–291. Conférence nationale de santé (2013). Avis sur la prise en compte de la crise économique sur les priorités et la politique de santé. Comment sortir plus forts de la crise? Paris, Ministère des Affaires Sociales et de la Santé, Direction Générale de la Santé (http://www.sante.gouv.fr/avis-du-02-04-13-sur-la-prise-en-compte-de-la-criseeconomique-sur-les-priorites-et-la-politique-de-sante-comment-sortir-plus-forts-dela-crise.html, accessed 5 March 2015). Conseil National de l'Ordre des Médecins (2013). Atlas de la démographie médicale en France. Paris, Conseil National de l'Ordre des Médecins. Coppoletta R (2012). Les attentes des Français en matière de protection sociale. Paris, Ministère de la Santé. Coppoletta R, Le Palud V (2014). Qualité et accessibilité des soins de santé: qu'en pensent les Francais? Paris, Ministère de la Santé. Couverture Maladie Universelle (2013). Fonds CMU, Rapport d'activité 2013. Paris, Couverture Maladie Universelle. (http://www.cmu.fr/fichier-utilisateur/fichiers/ Rapport_activite_2013.pdf, accessed 5 March 2015)
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98 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />
Caisse nationale de l'assurance maladie des travailleurs salaries (2013). Avenant<br />
No. 2 à la convention nationale. Paris, Caisse nationale de l'assurance maladie des<br />
travailleurs salaries (http://www.ameli.fr/professionnels-de-sante/pharmaciens/votreconvention/convention-nationale-titulaires-d-officine/avenant-n-2-a-la-conventionnationale.php;<br />
accessed 5 March 2015).<br />
Calvet L et al. (2013). Santé bucco-dentaire des enfants: des inégalités dès le plus<br />
jeune âge. Paris, Ministère des Affaires sociales, de la Santé et des Droits des femmes<br />
(DREES Studies <strong>and</strong> Results No. 847) (http://www.drees.sante.gouv.fr/sante-buccodentaire-des-enfants-des-inegalites-des-le-plus,11172.html,<br />
accessed 5 March 2015).<br />
Caniard É, Meyer C (2012). Les complémentaires et la crise?: menace ou<br />
opportunité? Les Tribunes de la Santé, 36(3):55–66.<br />
Chang S-S et al. (2013). Impact of 2008 global <strong>economic</strong> <strong>crisis</strong> on suicide: time<br />
trend study in 54 countries. BMJ, 347:f5239.<br />
Charpin J-M, Tlili C (2011). Perspectives démographiques et financières de la<br />
dépendance. Paris, Ministère des Affaires sociales, de la Santé et des Droits des<br />
femmes (http://www.social-sante.gouv.fr/IMG/pdf/rapport_g2_def-2.pdf; accessed<br />
5 March 2015).<br />
Chevreul K, Berg Brigham K (2013). Financing long-term care for frail elderly in<br />
France: the ghost reform. Health Policy, 111(3):213–220.<br />
Chevreul K et al. (2010). France: <strong>health</strong> system review. Health Systems in<br />
Transition, 12(6):1–291.<br />
Conférence nationale de santé (2013). Avis sur la prise en compte de la crise<br />
économique sur les priorités et la politique de santé. Comment sortir plus forts de la crise?<br />
Paris, Ministère des Affaires Sociales et de la Santé, Direction Générale de la Santé<br />
(http://www.sante.gouv.fr/avis-du-02-04-13-sur-la-prise-en-compte-de-la-criseeconomique-sur-les-priorites-et-la-politique-de-sante-comment-sortir-plus-forts-dela-crise.html,<br />
accessed 5 March 2015).<br />
Conseil National de l'Ordre des Médecins (2013). Atlas de la démographie médicale<br />
en France. Paris, Conseil National de l'Ordre des Médecins.<br />
Coppoletta R (2012). Les attentes des Français en matière de protection sociale. Paris,<br />
Ministère de la Santé.<br />
Coppoletta R, Le Palud V (2014). Qualité et accessibilité des soins de santé: qu'en<br />
pensent les Francais? Paris, Ministère de la Santé.<br />
Couverture Maladie Universelle (2013). Fonds CMU, Rapport d'activité 2013.<br />
Paris, Couverture Maladie Universelle. (http://www.cmu.fr/fichier-utilisateur/fichiers/<br />
Rapport_activite_2013.pdf, accessed 5 March 2015)
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