French health service on verge of collapse, says commission

A government commission has warned that without fundamental reforms France's national health service, rated the best in the world by the World Health Organisation, will collapse within the next 15 years.

The high council on the future of national health insurance said yesterday that if present trends continued, the service - forecast to finish this year €11bn (£7.3bn) in the red - will be a staggering €70bn (£47bn) over-budget by 2020.

The report's recommendations were welcomed by the minister, Jean-François Mattei, who has the unhappy task of reforming a uniquely generous national health service that most French people do not want tampered with.

Mr Mattei has vowed to present his plans before July.

The report came on a bad day for French public services: university rectors, at their annual conference, said that the country's further education system was in a state of "latent crisis" and that many governing boards may refuse to approve 2004 budgets in protest at inadequate funding. In a recent global survey of universities, the highest-ranking French establishment, Paris-VI, was placed 65th.

Most French patients think their health service is outstanding: it provides a first-class level of care for minimal personal outlay. Patients are free to go as often as they like to as many of the country's 94,000 GPs or 89,000 specialists, ask for whatever treatment or medicines they like, and expect to get most of the cost reimbursed by the state.

The system is, however, very expensive: France's healthcare budget is the world's third largest, accounting for 9.8% of GNP compared with 10.4% in Germany and 6.9% in Britain. And the system is also unnecessarily complex and wasteful, rewarding doctors who see patients as often as possible, and encouraging them to over-prescribe.

Partly as a result, the French are now Europe's heaviest pill-poppers, consuming more than three times as many as their neighbours in Britain, Germany and Italy.

The 53-member council said the service's finances were in a critical position, and described as unacceptable the long-term failure of successive governments to undertake essential reforms. Its report suggested the service's revenues could be boosted by raising the monthly contributions paid by the unemployed, and in particular by pensioners.

But the main thrust of the recommendations concerns improvements to the healthcare system itself, which the report criticised as "profoundly disorganised". It said the behaviour and expectations of both patients and professionals needed to change; and only drugs and operations that had been proven to be effective should be reimbursed. National insurance, the report said, "can no longer be a simple payment mechanism for a self-organised healthcare service".

Among the reforms, the council suggested increasing refunds given to patients who take preventative healthcare measures. It also demanded a more"critical" assessment of what drugs were covered, and said the whole sector, "from pharmaceutical companies to doctors, chemists to patients", needed to be told which medicines worked and could be prescribed for which illnesses.

"Otherwise, the system will simply collapse, trying to reimburse, with no attempt at selectivity, everything the pharmaceutical industry and the healthcare professions see fit to market," the report said.

"Nothing justifies the fact that French patients are prescribed between two and four times as many medicines as in the rest of Europe."