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HEALTH

How Macron intends to revive France’s ailing health system in 6 months

From plans to address medical deserts and incentives to support general practitioners to changes to working hours, here is how French president Emmanuel Macron hopes to 'overhaul' the French healthcare system by June.

How Macron intends to revive France's ailing health system in 6 months
France's President Emmanuel Macron addresses his New Year wishes to health care workers in Essone on January 6, 2023. (Photo by Ludovic MARIN / POOL / AFP)

French President Emmanuel Macron announced several “concrete” plans to reinvigorate France’s healthcare system during an address to hospital workers on Friday.

During a New Year’s speech at a hospital in Essonne, to the south of Paris, the French president began by acknowledging the “exhaustion” of healthcare workers, saying that the country’s health system was “at the end of the rope.”

Even though the president admitted there would be no “silver bullet” to solve the issues facing French healthcare, he promised to “completely overhaul work in the hospital sector by June 1st.” 

The speech came amid a ‘triple epidemic’ of influenza, Covid-19 and bronchiolitis that has overwhelmed French hospitals.  

Specifically, the president discussed plans to better organise working hours, address medical deserts, and make the field of primary care work more attractive, in part by hiring more administrative staff.

Reorganising working hours

Regarding working hours, Macron said that the application of the 35-hour work week had “profoundly disrupted hospitals” with its “hyperrigidity.” He said that a new version of the work week would better “represent the reality of your (doctor’s) daily lives.”

The president also said that “each départment must be able to organise itself autonomously” and “with maximum freedom regarding the construction of schedules.”

Macron said he hoped these changes would address the fact that many medical professionals feel “discouraged by impossible timetables.”

Finding solutions to medical deserts

Macron also discussed the issue of medical deserts, where communities do not have nearby access to a general practitioner.

In an effort to help remedy this issue, the president promised that the “600,000 patients in France who suffer from a chronic disease would be offered a primary care doctor – or at least a ‘reference team’ – by the end of the year.”

The president also discussed plans establish a “Conseil national de la refondation (CNR – or National Council for Reconstruction)” to build a “roadmap” for solutions in the fight against medical deserts.

Addressing the lack of general practitioners

Macron also recognised that by 2025 there would only be about 80,000 general practitioners in France, as many primary care physicians are expected to retire in the coming years and the field has suffered from low uptake. Macron said that the effects of this will begin to be most visible within “five to eight years.”

READ MORE: French GPs to extend strike action for another week

The president gave his speech amid an ongoing strike of general practitioners, which was extended until January 8th. Primary care doctors in France have been walking out in protest of working conditions and in hopes of securing more investment in the field to render it more attractive to young medical professionals.

Concretely, striking primary care doctors have demanded a doubling of the basic consultation fee – from €25 to €50 – primarily to help pay for administrative help to offset the time spent on bureaucratic tasks.

However, in his speech, the French president instead discussed potential investments to help make the primary care field more appealing.

The president said that the government would offer better pay to doctors who “take on new patients.”

Changing how the system is financed

The president also discussed plans to “move away from fee-for-service financing” instead toward “mission-based financing,” particularly referencing public hospitals.

He said that this has “created a lot of dysfunction in the system” and that changes would be made within the country’s next “Social Security financing bill” for 2023.

Recruiting medical assistants

The president also referenced the amount of time general practitioners are forced to spend on administrative work, and said that the government would accelerate the hiring of medical assistants, who could help relieve the administrative burdens of healthcare providers. 

The head of state said the country hoped to have “10,000 [medical assistants] hired by next year” – an increase from the “nearly 4,000 who have already signed contracts.”

Training more personnel

The French president also discussed plans to continue increasing the “number of places open” to access the healthcare profession via educational programmes, referencing an increase of 20 percent in the last three years.

However, Macron said that one of the primary issues is that many choose to leave during the training period. The president said that to remedy this, the scholastic system would need to do a better job of “properly measuring motivation.”

Macron said that a plan to “reorganise the educational system” would be put in place “by the summer.” He also discussed the issue of students choosing not to work in healthcare directly after finishing their studies, and referenced the possibility of instituting compulsory service in a position upon graduation for new healthcare workers.

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HEALTH

The different ways you can make a doctor’s appointment in France

Booking a medical appointment in France can be time-consuming – especially if you are new to the country and are looking for an English-speaking doctor.

The different ways you can make a doctor's appointment in France

You do not need a carte vitale to book a doctor’s appointment in France – anyone who needs medical help while in the country is entitled to it, but you may not be entitled to any reimbursement if you are not part of the social security system.

Booking a GP’s appointment can be as simple as phoning up your friendly neighbourhood GP, or using an online service such as Doctolib. 

It helps a lot, if you have a médecin traitant – an attending GP, who adds you (and your family, if they can) to their list of patients. 

READ ALSO Explained: How to register with a doctor in France

It is not always easy to find one. Some parts of the country are short of GPs, which means doctors’ lists can fill up very quickly. But it is important that anyone who lives in France is registered with a named GP, especially if they have a carte vitale.

As well as being the main point of contact between patients and the medical profession in all its guises, it is financially responsible to be registered with a GP in France.

Reimbursement on consultations is typically 70 percent through the French healthcare system, but just 30 percent for anyone without a declared doctor. Meanwhile, top-up mutuelle health insurance companies usually require you to declare a médecin traitant and if you don’t, you may not be able to receive reimbursements on certain treatments.

Bear in mind, it is your responsibility to register with a local médecin traitant. But, even after you have done so, you can still make an appointment with any doctor, anywhere in France, and arrange specialist treatment, if you need it. 

READ ALSO 5 things to know about visiting a doctor in France

How do you go about making a GP appointment in France?

There are several options.

Some health centres – more often in larger towns and cities – operate a walk-in policy. But expect waits to be lengthy. Do not, however, assume that your GP operates a system like this.

You can phone for an appointment. This is another very common method. Your GP will have their own system for making appointments – which may even include something that looks, to the uninitiated, very much like a casual walk-in policy. 

Some may have an assistant to deal with booking appointments and other administration. Others may deal with appointments themselves, and may – for example – operate some sort of triage system based on voice messages from patients. 

What about online booking systems?

And many practitioners are now attached to websites, such as Doctolib. As of 2023, about half of all GP appointments in France were made using Doctolib.

READ ALSO How to use: French medical website Doctolib

Be aware that other online booking systems are available. Doctolib is one of the best known, but your GP may be attached to another system, like the health ministry approved site ‘LeMedecin.Fr’.

This website also has a feature where you can take an immediate online consultation with whatever doctor is available at that moment. By clicking ‘Consultez en vidéo maintenant’ you will be connected to the next doctor who is free. This option may involve an additional charge between €5-10 on top of the price of the consultation, and you will be expected to pay when booking.

If you have any trouble with either of these websites, you can go through the list of registered generalists per département on the ‘Ameli’ website. If you use this option, you will need to call the doctor to see if they are open or available for appointments.

In terms of wait times, online systems have helped to significantly reduce the delay between booking and getting an appointment.

According to a 2023 study by Doctolib, about half of all GP appointments were available within three days from the time of booking on their platform.

Similarly, you can use online platforms to check the medical professional’s qualifications and languages spoken, as well as filter based on the doctor’s English abilities. However, this should be taken with a grain of salt because not every medical professional with English listed on their Doctolib page speaks fluent English. 

An increasing number of doctorsoffer video consultations, known as télémédecine in France. This allows professionals – particularly those in more rural areas – to diagnose less serious conditions remotely. This type of consultation is usually only available from those medical practices that are attached to online booking systems. 

Some pharmacies have also begun offering walk-in télémedicine consults, using ‘Medadom’ machines. More information here.

What about specialists?

In France, you book your own consultations with specialists, even if you are referred by a doctor (your GP may offer a recommendation, but won’t always). The good news is that many specialists do use online booking services. Those that do not usually have assistants to take care of the appointments.

READ ALSO: Urgent care: How to get non-emergency medical treatment in France

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