J. M. CHABOT
The French Republic is one of the largest countries in Europe in land mass, with a population of approximately 56 million, a heavily industrialized economy, and a 1986 per capita GNP of $10,740. Birth and death rates are about average for Europe as a whole, and general health conditions compare favorably with other developed nations. Elementary and secondary education is publicly funded; a baccalaureate is the minimum qualification for entry to higher education.
The French health care delivery system is insurance-based, with central and local government controls. The social security system created in 1945 is a single nationwide service with a National Fund (Caisse d'Assurance Maladie) that oversees the regional and local funds. Fund representatives are elected by the contributors. The social security system provides three main services: health care coverage, old-age pensions, and family allowances. The money for the funds is drawn directly from the contributors' salaries. Health care insurance is based on gross salary, and the coverage provided ranges from 55 to 90 percent depending on the services rendered.
The health and social services administration is organized in four levels: national ( Ministry of Health under the Ministry of Social Security); regional (Regional Prefect, Regional Department of Health and Social Security, and Regional Council); department (Prefect, Departmental Health and Social Security Administration, and General Council); and committee (councilors and local Departments of Health and Hygiene).
Ambulatory health care is based on a free-market system for physicians and paramedical personnel. Negotiations between the administrative authorities and health care professionals, under the guidance of the National Insurance Fund, determine agreements (conventions) on fees. The patient pays the health care professional directly after receiving care and is subsequently reimbursed from the