Is France’s envied health care system threatened?

Thousands of French doctors and health professionals will take to the streets in Paris on Sunday to protest against reforms they say will threaten the quality of France's renowned health care system. The leader of the demonstration tells The Local why the government must listen.

Is France's envied health care system threatened?
Doctors take to the streets of Lyon in january to protest health reforms. Photo: Jeff Pachoud/AFP

For doctors in France the issue is clear.

The reputation of the country's health care system as the best in the world is at stake.

In recent weeks France has seen doctors in hospital emergency wards go on strike over working conditions and a police memo warned that hospitals are at breaking point due to a shortage of beds and poor working conditions for staff, all exacerbated by a winter flu epidemic.

“It's like Thatcher's Britain,” said the unions.

Health professionals have long demanded reforms but the minister of health’s bill, set to be discussed in parliament next week, has only served to provoke more anger among family doctors (GPs), who claim the quality of care they can offer will be severely undermined.

The reform prompted doctors to closed their cabinets over Christmas as part of nationwide industrial action and they vowed to create a bureaucratic mess for the government.

Their main of bone of contention is health minister Marisol Touraine’s plan to bring an end to a system, known as “tiers payant”, which sees patients in France pay upfront to see a doctor, 

'A battle to save the French model'

The money handed over by patients, normally €23 for a consultation is then refunded mostly by the state's social security system and the rest by private insurance companies known as “mutuelles”.

The reform, which was an election promise of President François Hollande’s and demanded by the public will instead see doctors bill the state and private insurance companies for patients' visits.

Dr Eric Henry who will lead Sunday’s march to the Ministry of Health in Paris told The Local that France’s health service will no longer be the envy of the world if the reforms pass.

“This is a battle to save the French model. When we look at other countries we are always proud to be French because we know at the end of the day we will receive good health care here,” said Henry.

“This is the country where everyone around the world would like to receive treatment.”

The doctor leads the organisation Movement for Health for All which was created in February to bring health professionals together under one umbrella group under the slogan: “No to the health reform, united for the future of health care”.

'Doctors know their profession will be ruined'

“On Sunday we will see many doctors aged in their 50s and 60s, who are close to retirement, take to the streets in protest. They know that if it continues like this their profession will be ruined.”

Doctors say scrapping the system of paying upfront will see them lose their independence and will end up with them being “dictated to” by insurance companies who they will have to apply to for all reimbursements – basically their salaries.

Not only will it mean doctors having to spend hours filling in paperwork, but they will end up with less time with their patients and less independence to give the public the care they need.

“Having the patient pay upfront is the key to the system,” says Henry. “In France the quality of care is good because doctors are independent.

“Currently it’s not the social security system that pays me, it’s not the minister of health who pays me, it’s my patients. I am responsible for their health,” he said.

'What is the best for my patient?'

“If we change the system, it will be whichever insurance company pays me, who is responsible. The Social Security service will say to me 'Mr Henry you are prescribing too many antibiotics’, ‘you are prescribing too many pills and sending people for too many tests’ and they will tell me I have to prescribe less.

“I will no longer be free to ask the question 'what is the best thing for the patient’s health?' I will no be longer be independent.”

Henry also fears that without patients having to pay upfront they are more likely to visit the doctor “for any old reason”, which will mean he will have less consultation time with each patient.

'It will end up like in the UK,” he says.

The Movement for Health for All is hoping as many as 40,000 doctors take to the streets on Sunday to put pressure on the government, which so far has turned a deaf ear to their concerns.

“The Health Minister is not listening and that’s why we are protesting on Sunday. And we’ll continue to protest. If she pulls her plan then we’ll stop our protests, but if she doesn’t listen then we’ll continue. At the moment we are not sure what we will have to do to make sure she drops the reform.”

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Monkeypox in Germany: Two teens ‘among new infections’

Two teenage boys between the ages of 15-17 have reportedly been infected by monkeypox, as the number of cases in Germany continues to grow.

Monkeypox in Germany: Two teens 'among new infections'

German news site Spiegel Online first reported the new cases – which are an anomaly for a virus as it has mostly affected gay men – following an inquiry to the Robert Koch Institute (RKI). 

They are among a total of 2,677 people who are confirmed to have contracted the virus in Germany to date. There have not been any fatalities.

Out of these, only five cases were women, according to the RKI. The public health institute said that it does not release information on individual cases.

READ ALSO: EXPLAINED: How Germany wants to contain the monkeypox

The disease – which is not usually fatal – often manifests itself through fever, muscle aches, swollen lymph nodes, chills, exhaustion and a chickenpox-like rash on the hands and face.

The virus can be transmitted through contact with skin lesions and droplets of a contaminated person, as well as through shared items such as bedding and towels.

Many of the cases known so far concern homosexual and bisexual men. However, affected people and experts have repeatedly warned against stigmatising gay communities.

How fatal is the disease?

The first monkeypox cases were reported in Germany on May 20th, as the disease continued to spread in West Europe.

At the weekend, the first two deaths outside of West Africa were reported in Spain.

READ ALSO: WHO warns ‘high’ risk of monkeypox in Europe as it declares health emergency

The RKI has urged people returning from West Africa and in particular gay men, to see their doctors quickly if they notice any chances on their skin.

According to the latest estimates, there are 23,000 monkeypox cases worldwide, and Europe is particularly affected with 14,000 cases.

There have been 2,677 monkeypox cases in Germany as of August 2, 2022. Photo: CDC handout

About eight percent of patients in Europe have been hospitalised so far, reported the World Health Association on Monday, mostly due to severe pain or additional infections.

In general, the mortality of the variant currently circulating in Europe is estimated to be low.

READ ALSO: More cases of monkeypox ‘expected’ in Germany

Will a vaccine make a difference?

Since July, a vaccine has been authorised in 27 EU member states and in Iceland, Liechtenstein and Norway. 

The Standing Committee on Vaccination (STIKO) recommends vaccination against monkeypox in Germany for certain risk groups and people who have had close contact with infected people.

So far, the German government has ordered 240,000 vaccine doses, of which 40,000 had been delivered by Friday. 

Around 200,000 doses are set to follow by the end of September. 

The German Aids Federation (DAH) on Friday called for one million vaccine doses, stressing that the current supplies will fall short of meeting need.

“The goal must be to reduce the number of infections as quickly as possible and to get the epidemic permanently under control,” explained Ulf Kristal of the DAH board in Berlin on Friday.

But this is only possible, he said, if as many people at risk of infection as possible are vaccinated.

“We don’t assume the epidemic will be over when the doses available so far have been vaccinated,” Axel Jeremias Schmidt, Epidemiologist and DAH Consultant for Medicine and Health Policy, wrote in a press release.

As long as there are monkeypox infections, he said, people who are at risk must be offered vaccination.