Health care in France

From Wikipedia, the free encyclopedia

The French health care system is one of universal health care largely financed by government national health
insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France
provided the "close to best overall health care" in the world.[1] In 2011, France spent 11.6% of GDP on health care,
or US$4,086 per capita,[2] a figure much higher than the average spent by countries in Europe but less than in the
US. Approximately 77% of health expenditures are covered by government funded agencies.[3]
Most general physicians are in private practice but draw their income from the public insurance funds. These funds,
unlike their German counterparts, have never gained self-management responsibility. Instead, the government has
taken responsibility for the financial and operational management of health insurance (by setting premium levels
related to income and determining the prices of goods and services refunded).[1] The French government generally
refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental
coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until 2000, coverage was
restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments
of the population; the government of Lionel Jospin put into place universal health coverage and extended the
coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through
private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and
dental care (35.9%) (Figures from the year 2000). There are public hospitals, non-profit independent hospitals
(which are linked to the public system), as well as private for-profit hospitals.

History
The reduction in infant mortality between 1960 and 2008 for France in comparison with Ireland, Switzerland,
Sweden, the United Kingdom, and the United States.
The current system has undergone several changes since its foundation in 1945, though the basis of the system
remains state planned and operated.[6]
Jean de Kervasdou, a health economist, believes that French medicine is of great quality and is "the only
credible alternative to the Americanization of world medicine." According to Kervasdou, France's surgeons,
clinicians, psychiatrists, and its emergency care system (SAMU) are an example for the world. However,
despite this, Kervasdou criticizes the fact that hospitals must comply with 43 bodies of regulation and the nitpicking bureaucracy that can be found in the system. Kervasdou believes that the state intervenes too much in
regulating the daily functions of French hospitals.
Furthermore, Japan, Sweden, and the Netherlands have health care systems with comparable performance to
that of France's, yet spend no more than 8% of their GDP (against France's spending of more than 10% of its
GDP).
According to various experts,[who?] the battered state of the French social security system's finances is causing
the growth of France's health care expenses. To control expenses, these experts[who?] recommend a
reorganization of access to health care providers, revisions to pertinent laws, a repossession by CNAMTS of the
continued development of medicines, and the democratization of budgetary arbitration to counter pressure from
the pharmaceutical industry.

Health care system

Total health spending per capita, in U.S. dollars PPP-adjusted, of France compared amongst various other first
world nations.
The entire population must pay compulsory health insurance. The insurers are non-profit agencies that annually
participate in negotiations with the state regarding the overall funding of health care in France. There are three
main funds, the largest of which covers 84% of the population and the other two a further 12%. A premium is
deducted from all employees' pay automatically. The 2001 Social Security Funding Act, set the rates for health
insurance covering the statutory health care plan at 5.25% on earned income, capital and winnings from
gambling and at 3.95% on benefits (pensions and allowances).[7]
After paying the doctor's or dentist's fee, a proportion is reimbursed. This is around 75 to 80%, but can be as
much as 85%.[citation needed] The balance is effectively a co-payment paid by the patient but it can also be
recovered if the patient pays a regular premium to a voluntary health insurance scheme. Nationally, about half
of such copayments are paid from VHI insurance and half out of pocket.
Under recent rules (the coordinated consultation procedure, in French: "parcours de soins coordonn"), general
practitioners("mdecin gnraliste" or "docteur") are expected to act as "gate keepers" who refer patients to a
specialist or a hospital when necessary. However the system offers free choice of the reference doctor, which is
not restricted to only general practitioner and may still be a specialist or a doctor in a public or private hospital.
The goal is to limit the number of consultations for the same illness.[8] The incentive is financial in that
expenses are reimbursed at much lower rates for patients who go directly to another doctor (except for dentists,
ophthalmologists, gynaecologists and psychiatrists); vital emergencies are still exempt from requiring the
advice from the reference doctor, which will be informed later. As costs are borne by the patient and then
reimbursed, patients have freedom of choice of where to receive health care services.[8]
Around 65% of hospital beds in France are provided by public hospitals, around 15% by private non-profit
organizations, and 20% by for-profit companies.[citation needed]
Minister of Health and Solidarity is a cabinet position in the government of France. The healthcare portfolio
oversees the public services and the health insurance part of Social Security. As ministerial departments are not
fixed and depend on the Prime Minister's choice, the Minister sometimes has other portfolios among Work,
Pensions, Family, the Elderly, Handicapped people and Women's Rights. In that case, they are assisted by
junior Ministers who focus on specific parts of the portfolio.

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The tongue is made up almost entirely of muscle fibres. It can be divided into an oral portion (tip, blade, front,
centre and back) and a pharyngeal (throat) portion.
The movement of the tongue against the roof of the mouth, teeth and lips helps us to shape vocal sounds into
words, as well as to eat and drink effectively. The taste buds located on the tongue membrane contribute to the
experience of food flavour.
The dense network of nerves and muscle fibres in the tongue means that we can chew food without (usually)
chewing on our tongue as well. Some of the disorders that affect the tongue include sore tongue, black hairy
tongue and tongue-tie.
Tongue anatomy
The base of the tongue is located in the throat just above the larynx (voice box) and extends to the hyoid bone.
The tongue is wrapped in the lingual membrane, which is studded with tiny projections called papillae. These
papillae are responsible for the tongues textured surface. At the back, sides and tip of the tongue are the taste
buds. These help to distinguish basic food flavours including bitter, salty, sweet and sour. There are about 9,000
taste buds on the average adult tongue. Some taste buds are found in the throat and palate.

Taste buds explained

A taste bud consists of a cluster of receptor cells, and each cell is topped with a fine, hair-like projection called
a microvillus. The receptor cells are connected to a mesh of nerves that transmit taste to the major nerve bundles
including the facial nerve and the glossopharyngeal nerve. From there, taste information is sent to the brain and
combined with olfactory information from the nose. Contrary to popular belief, the main organ of taste is the
nose. Our sense of smell is thought to be about 10,000 times more acute than our sense of taste, which is why
we cant detect most food flavours when we have a cold or blocked sinuses.

Taste buds contain the receptors for taste. They are located around the small structures on the upper surface of
the tongue, soft palate, upperesophagus, the cheek, epiglottis, which are called papillae.[1] These structures are
involved in detecting the five (known) elements of taste perception: salty, sour, bitter, sweet, and umami. A
popular myth assigns these different tastes to different regions of the tongue; in reality these tastes can be
detected by any area of the tongue. Via small openings in the tongue epithelium, called taste pores, parts of the
food dissolved insaliva come into contact with taste receptors. These are located on top of the taste receptor
cells that constitute the taste buds. The taste receptor cells send information detected by clusters of various
receptors and ion channels to the gustatory areas of the brain via the seventh, ninth and tenth cranial nerves.
On average, the human tongue has 3,00010,000 taste buds.[2]

The majority of taste buds on the tongue sit on raised protrusions of the tongue surface called papillae. There are
four types of lingual papillaepresent in the human tongue:

Fungiform papillae - as the name suggests, these are slightly mushroom-shaped if looked at in longitudinal
section. These are present mostly at the dorsal surface of the tongue, as well as at the sides. Innervated by
facial nerve.

Filiform papillae - these are thin, long papillae "V"-shaped cones that don't contain taste buds but are the most
numerous. These papillae are mechanical and not involved in gustation. They are characterized by
increased keratinization.

Foliate papillae - these are ridges and grooves towards the posterior part of the tongue found at the lateral
borders. Innervated by facial nerve (anterior papillae) and glossopharyngeal nerve (posterior papillae).

Circumvallate papillae - there are only about 10 to 14 of these papillae on most people, and they are present at
the back of the oral part of the tongue. They are arranged in a circular-shaped row just in front of the sulcus
terminalis of the tongue. They are associated with ducts of Von Ebner's glands, and are innervated by the
glossopharyngeal nerve.