|Implemented in this survey?|
The main objective of this policy is to improve the availability and quality of public data on the demographics of health professionals. Other objectives are to track inequalities in the distribution of medical work force, to estimate the future needs and to make recommendations. Medical manpower deprived areas will benefit from financial incentives to retain health professionals. The Government also experiment the possibility of delegating certain medical tasks from physicians to paramedics.
A National Observatory of Health Professionals (ONDPS) is created in order to follow and supervise the evolution of health professional work force. Confronted with a reduction in medical manpower in the next ten years, this policy aims to produce and diffuse the information on the current and future needs for health professionals in order to reform the planning and education of Health Workforce as well as to promote coordination between the main stakeholders at national and regional level.
The National Observatory of Health Professions (ONDPS) has been created in 2003 by the Ministry of Health. The president and main members of the orientation council (10) are appointed by the
Health Minister, other members are chief officers (4) of the Ministry of Health.
The major responsibilities of the National Observatory of Health Professionals (ONDPS) are to collect, analyse and communicate data and information on all categories of health care professionals. The ONDPS also promotes research on working conditions, planning of health professionals, and evolution of medical professionals. It also works in cooperation with regional observatories. In each region of France there is a Regional Observatory of Health Professionals bringing together the regional representatives of physicians, the state authorities, the sickness funds, hospital agencies and Health Observatory. Those regional observatories coordinate the studies and initiatives to improve health professionals demography.
Moreover the ONDPS supervises the experimental work on the delegation of certain medical tasks from physicians to paramedical staff. Skill mix and especially delegation of tasks from physicians to paramedics is considered as a major issue by the ministry of health, but the process of experimentation goes slowly.
Medical doctors, mainly general practitioners, will receive financial incentive if they settle in the areas identified as under served. But currently there is no clear specification of the nature
of these incentives. A number of incentives have already been introduced in the last couple of years to attract health professionals in both public hospitals and in private ambulatory sector in areas
where there is a lack of medical personnel. For example, there were premiums for the physicians working in public hospitals. There are also fiscal facilities for General Practitioners who want to
establish in underserved areas.
The idea is to re-enforce the health work force, particularly in primary care in "deprived areas" identified by the observatory.
Medical doctors, Other regulated health care professionals
|Medienpräsenz||sehr gering||sehr hoch|
The introduction of 35 hours week in France, and the EU legislation on work time (Directive 93/104/EEC on the organisation of working time) created new demand for health care professionals.
Moreover, the feminisation of medical doctors (60 % of students entering medical studies in 2002), and the change in the young professionals' attitude towards work meant a significant reduction in
health professionals' working time. Public actors and especially doctors realized suddenly that a shortage of physicians and nurses is at the door if nothing is done.
Also, there are large inequalities in the distribution of health work force in France; in some regions of the north per capita doctors being 60 % of the south. Currently there are two main tools of medical demographic regulation: numerus clausus which limit the number of students allowed to enter medical studies, and the Examen National Classant, which ranks medical students to their specialty after 6 years of medical study. These tools appear inefficient to guarantee an adequate number of specialists between specialties and on the overall territory of France.
The idea of medical shortage is controversial, since there are no exhaustive data available on the actual distribution of different health professionals. Data come from different sources for different categories of health professionals. This is due to coexistence of different context of practice. For instance; the National Health Insurance Institution collects data on private ambulatory doctors and on doctors who work in private hospitals, while Ministry of Health collects data on doctors who work in public hospitals. The National medical council (Conseil National de l'Ordre des Médecins) has also its own data base. The first step was to consolidate databases to describe the medical workforce in France.
In the last years, at the regional level there has been an increasing anxiety about the declining number of general practitioners in rural areas. The Ministry of health reacted their demand by creating in 2005 a special committee chaired by the head of the ONDPS. This committee suggested a number of measures to reduce regional inequalities, but expressed their respect for the "free setting up" of medical doctors. This implies that there is no real dis-incentives for those doctors who want establish in high-density areas.
Directive 93/104/EEC on the organisation of working time
|Implemented in this survey?|
The original policy idea comes from the left government in 2000 and has been implemented in 2003 by the actual liberal government. A large number of reports have been produced in the last five years to estimate the consequences of medical work force reduction, mostly looking at the distribution of health professionals in ambulatory sector at the regional level. The recommendation to pilot and supervise health workforce at national level was constant in national reports. The idea to share information on health professionals between the actors in health sector (professional bodies, state administration and national insurance company) is new. The pressure of a possible future shortage of health labour force, relayed largely by media and local politicians, drove state authorities to take initiative, which is very consensual for the moment. By creating the ONDPS, which produce comprehensive data and information, the Government aims to better control the supply and overall distribution of medical doctors and other health professionals.
The approach of the idea is described as:
All stakeholders agree to better observe the demographics of health professionals and to assess the situation with objective data.
The idea to transfer medical competencies (skill mix) to paramedics is more controversial. There is no consensus on the subject as this implies a possible reduction of income for certain professional groups and a change in professional boundaries for others. Actual ministry of health is less voluntary than his predecessor, even if he confirmed that he will continue on this project. Hospital federations (private and public), some nurse trade unions, parts of medical organizations support the idea to change skill mix.
The alternative proposed by the national medical council (Conseil National de l'Ordre des Médecins) is to increase significantly the total number of medical students. The Ministry of Health is preparing a medical plan for the end of 2005. This plan will include some reports and recommendations of ONDPS and will arbitrate conflicts between stakeholders.
|Elite of doctors: leaders of medical schools||sehr unterstützend||stark dagegen|
|Elite of doctors: leaders of medical schools||sehr groß||kein|
No evaluation has taken place.
The Observatory has published a first report in 2004. It proposes some recommendations as health supply restructuring (group practice both in primary and secondary care, redefinition of health
professions) and change in medical and paramedical education (strong general education for doctors before specialization, medical training outside teaching hospitals, and reinforcement of paramedical
The results have been very successful in colloquium and media. The level of knowledge of stakeholders is higher. The ONDPS is recognized in the Health Sector as a reliable source of data, analyses and recommendations. At the same time, the expectations for policy decisions is growing.
Health Minsiter is préparing a medical plan for end of the year. Some proposals from ONDPS will be included. Main idea remains unknown for the moment.
An undesirable effect could be the lack of credibility if the recommendations of the observation is not followed by active policies. In that case, consequences in healthcare could be a reduction of access and a lower quality.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Impact of this policy remains uncertain. It depends on political choices to guarantee equal access to care. Choices will be controversial and unpopular for certains groups of professionnals.
The ONDPS has been created by the Government by a decree (Décret n° 2003 - 529 du 19 juin 2003 portant creation de l'Observatoire National de la Démographie des Professions de Santé). www.legifrance.gouv.fr/WAspad/Visu?cid=609385&indice=60&table=JORF&ligneDeb=1
There is an act in « LOI n° 2004-806 du 9 août 2004 relative à la politique de santé publique, article 131 » allowing the experimentation of transfer of certain tasks from physicians to paramedics. www.legifrance.gouv.fr/WAspad/Ajour?nor=SANX0300055L&num=2004-806&ind=1&laPage=1&demande=ajour