The state and health in France

The Health Service in France (as indeed must be the case in many other countries) has been affected by a new technical dimension, which now adds its weight to the two main criteria, social and economic, which influence health provision. In the technical domain, new methods in research and treatment have transformed the nature of medical 4practice, which is more and more prey to disruption at the sudden appearance of ever more complex technologies. Medical treatment can be said to have become fragmented in some sense, and the process of division of labour within medicine to have undergone considerable development. As a result of these modifications, but also because of changes in society as a whole (the ageing of the population, altered needs and expectations), the amounts spent on health provision are growing at a higher rate than the Gross Domestic Product. This is leading the participants who control and finance the system (the State, Social Security) to think in terms of selectivity and efficiency and the medical profession itself to be willing to consider the economic implications of its activities. Moreover, the Health Service is highly valued by public opinion, as shown by a number of polls. It is a major social priority for the population, represented by the health insurance organizations whose function is to make use of their funds, raised by obligatory contributions, to strive to ensure equal access for all to the most advanced treatments and techniques. It can be shown that the evolution of the Health Service has been shaped by three differing types of underlying logic: the professional (because the technical side is chiefly represented by the professionals who personify the scientific and technical aspects of health problems), the social and the economic. Until about 1968, the social and professional rationales prevailed. From then until the change in political majority that culminated in the arrival in power of the left in May 1981, economic criteria outweighed social, and the autonomy of the professionals was strongly curtailed. Finally, in the current phase, social factors tend to have priority over economic, though without their importance being overlooked, and there is an effort to group the professionals around projects aimed at fulfilling social needs and aspirations.