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Andrew Scull (ed.), Cultural Sociology of Mental Illness : an A-to-Z Guide , Sage, 2014, pp. 316-17
France is a unitary semi-presidential republic and a member of the European Union. On 1st January2012, the country had a population of 65.3 million. In 2010, it had a very high Human DevelopmentIndex (HDI) of 0.872. This figure notably takes into account French life expectancy, which is oneof the longest in the world.Created in 1945, the “sécurité sociale” is a cornerstone of the French social protectionsystem. The institution’s mission is to provide financial assistance to its beneficiaries when theyencounter costly life events. The health care arm (that includes pregnancy, disability and death) isthus a model of “Universal health care” and funds a substantial portion of the health care system, with the rest falling to private insurance, often through non-profit mutual insurers. The number of doctors per 1,000 inhabitants (3.22 in 2008) is one of the highest in the world. In 2010, the WHOconcluded its global evaluation of health care systems by underlining that France provided “close to best overall health care” in the world.The French mental health care system is organized within this framework.
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(the summary in French is below). Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France. Depuis 1945, les politiques de santé en France s’appuient sur une conception sociale s’inspirant de deux principes : l’universalisme et l’égalité. Le système de santé français repose en effet sur un système de sécurité sociale obligatoire et fortement redistributif, financé par les contributions sociales et co-administré par les organisations patronales et salariales, sous le contrôle de l’Etat. Ce système est fréquemment désigné comme le « modèle français ». Dans cet article, le premier du numéro spécial du Lancet sur la France, nous remettons en question quelques idées reçues sur l’accès à la santé en France. Dans un premier temps, nous ouvrons la réflexion sur les transformations politiques et institutionnelles qui ont affecté la gouvernance de la santé au cours des dernières décennies. Nous montrons d’une part que le système de santé, loin d’être uniforme, repose sur une diversité d’institutions, mécanismes et acteurs des politiques de santé, d’autre part que la gouvernance de la santé a été marquée par une tendance au renforcement du rôle régulateur de l’Etat. Dans un second temps, nous suggérons que les mécanismes de redistribution du système d’assurance maladie sont bien actifs, mais que leur efficacité reste entravée par les inégalités sociales de santé, lesquelles constituent des obstacles majeurs à la réalisation des objectifs de justice et de solidarité qui sont au cœur de la conception sociale de la santé en France.
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Since its inception in 1946, the French national health insurance has been developed as an employment-based statutory system. Initially for salaried workers and their families, it has been progressively extended to agricultural workers (1961) and to self-employed workers (1966). In 2000, the Universal Health Coverage Act (CMU Act) introduced a right to statutory health insurance coverage on the basis on
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