The preferred doctor scheme: A political reading of a French experiment of Gate-keeping
Section snippets
Paper objectives
Like most developed countries, France confronts escalating health costs driven by the intensive use of technology and growing consumption of services. Regulators must contend with inefficiencies in the organization, provision, and delivery of services as well as problematic financial incentives for health professionals and consumers. Although the evidence base is far from clear, advocates of Gate-keeping (GK) have promoted it as a powerful tool that regulates both the demand and supply sides so
Political context: an earlier reform
Gate-keeping has spurred intense debate in France since the early 1990s. Various experts and policymakers endorsed it, but the majority of the politically powerful specialist unions were opposed. Finally, in 1998, a first attempt at GK – the “referring doctor” approach – won the support of both the NSF and “MG France,” a union of GPs with a social democratic orientation, which thought the innovation important to its broader aim to enhance the political status of GPs in relation to specialists.
On the demand side
As of June 2007, 81% of patients had signed a contract with a PD, 99% of which were GPs [14]. Formally the scheme was not compulsory, but 81% of the sample thought that it was and offered this as by far the main reason for participating. The second most common reason for contracting, consistent with the first one, was fear of financial penalties (44%). Only 31% said they had joined because doing so would generate savings for the NSF, a mere 16% declared that they expected their participation to
The preferred doctor scheme: political success, economic failure?
Economist Jamie Robinson wrote that in the United States managed care was an economic success but a political failure. The PD scheme in France, we argue, is the reverse, namely, a short term political success, but (at least so far) an economic failure.
Acknowledgments
The authors wish to thank L. D. Brown (University of Columbia), T. C. Ricketts (University of North Carolina) and G. Bevan (London school of economics and political science) for their precious suggestions and remarks.
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