FRE105Handout11

Handout 13: Health Care and Social Care

Check topics on :"Discovering France" on http://www.diplomatie.gouv.fr/en/
Summary of FRANCE-Social/Health Care

1945 : Creation of Sécurité Sociale and Nationalizations under de Gaulle.
Health is a major concern of the French: in 1998, they spent 110.6
billion euros on medical care and goods. 75% of this was covered by
the social security system, with an increasing proportion being met by
households and insurance companies.

The SECU: Universal social protection, regardless of income, is a comprehensive system called Sécurité Sociale.

-National Health Insurance (which covers risks relating to illness,maternity, disability and death)
-Sécurité Sociale also provides concrete assistance for raising children
-Old age: medical procedures and retirement, through an old age pension fund :obligatory retirement system (49% of the payment). The contribution period is 37.5 years on average.
-Unemployment benefits represent 9% of the spendings made by the Sécurité Sociale.
France has one of the most effective welfare systems in the world.
-one of the highest in the European Union, comparable to that of Denmark, Finland, Austria and the Netherlands.
E.g                   Benefits break down as follows: pensions (49.2%), health (27.2%),
                        family allowances (12.8%) and employment aid (unemployment benefit,
                        vocational training and social integration) (8.4%).

I. HEALTH CARE-Health for all CMU ( universal sickness coverage/Couverture maladie universelle )

- free supplementary cover. Eligibility for supplementary cover is means-tested (EUR 533.57 per month for a single person). people are also eligible for dental treatment and prescriptions for glasses which they previously tended to do without.

smart card, the Sésame Vitale: health record card (see wiki and http://www.gemalto.com/brochures/download/france_health.pdf) issued to all French and foreign contributors to the French national insurance scheme, on which doctors record important medical information, such as tests, consultations, prescribed treatments, etc..
Private practice plays an important role and the patient is free to choose his or her health-care provider.
France's health policy is designed to ensure equal access to health care for the entire population. Although some disparities remain as a result of differences in living standards, education or place of residence, these are much less marked than for many other items of household expenditure.
The public authorities are also endeavouring to develop preventive medicine, organizing large-scale public-health campaigns on major health risks. France's infant mortality rate is amongst the lowest in the world and its life expectancy is amongst the highest, increasing by approximately 100 days every year.
Alternative medecine (homeopathy/ acupuncture/ water treatments at spas etc.) is prescribed, recognized and reinbursed by the Health Scheme.
Since 1998, health care has no longer been funded only by national insurance deducted from the salaries of employees, but by a tax,
the CSG (generalised social contribution), levied on all gross earned and unearned income.

DEFICIT: French Social Security system which reached 2.3 billion d'euros in 1998. By 1999, this had fallen to 0,60 billion d'euros thanks in particular to the introduction of a temporary extra levy (CRDS).

II. SOCIAL CARE: State= role & responsability= Protection and Provider of Jobs/Law...

Broader central government role.

This commitment transcends political divisions.

While there is undoubtedly more support for public service on the left than on the right, in the last ten years we have seen all governments, whether right-wing or left-wing, taking very similar public positions on this subject, particularly in European debates.

The commune is the lowest tier of France's administrative hierarchy.

The préfet (Governor of a region) is a high-ranking civil servant who represents the State at the level of the department or region. Besides a range of important administrative duties, the role of the préfet is to ensure that central government decisions are carried out properly at local level.

Public Services ; in the public interest, which, one way or another, are carried out by the authorities.

The courts, the police, education, disease prevention and health promotion are all public services , rail transport and the supply of electricity.

Long term unemployment and RMI (reinsertion revenue, minimum allowance)

Defence: French Army (voluntary)/ the French Legion: Peace keeping.

Environment:In order to conserve and develop France's natural heritage, the government has established six national parks, 128 nature reserves,430 designated areas for protected species and 299 protected coastal areas. France also has 29 regional nature parks covering more than 7% of the country.22.11 billion euros are allocated to the protection of the environment -

378.07 euros per inhabitant. Three quarters of this goes on waste water management and waste disposal.
Since the Rio and Kyoto meetings and the World Summits on the Environment and Global Sustainable Development, France and the European Union have taken collective initiatives in view of protecting the environment. These have materialized in laws which demand that governments down to the local level draw up and implement actions and projects in line with the laws.(e.g. recycling/ clean air, clean water acts etc.).France is a key player in this movement. They created ECO-labels for products respecting the environment in their fabrication processes.

Terms:
SECU: Social Security
RMI:Minimum insertion wage (welfare for those who do not qualify for unemployment benefit)
SMIC: Minimum wage )
CMU: universal sickness coverage
CSG: Generalized social contribution from a tax levied on all gross earned and unearned income.

Discussion questions
1. What does the SECU cover?
2. Outline the French health care system called CMU. Are patients restricted to a list of doctors?

3. If the patient wants acupuncture, is it covered by their health care?

4. What are the advantages of this health care system? Do you see some problems ?

5. How is this health care funded?

6. What is the Sésame Vitale card?

7. What are SMIC?

8. Are health care and pension plans for everyone?

9. What are the respective strengths and weaknesses or the French and USA medical and social care ?

10.What main differences seem to exist between the ways of the US and of the French in terms of general attitudes to public services , what are the constraints and the freedoms?

View documentary:Interview with a doctor-and film Sicko (M Moore)

Films: (1) Sicko (M Moore) American maverick compares US healthcare with others (France, English, Cuba...)
(2) Romuald et Juliette (Mama there is a man in your bed)
Social satire. 1. the portrayal of the "haves" and "have nots in France. 2. their values, housing and preoccupations 3. their interactions within the families 4. attitudes towards school 5. love and marriage 6. References to the health care system or the social services 7. References to social prejudices.