Should one control health expenditure ?

Although the medical sector is one of the most flourishing sectors of the economy, it is a matter of urgency to limit ever-increasing health expenditure in view of the parlous financial state of the French national health and pensions organisations. It is even more urgent because this growth is clearly not proportionate to a similar increase in life expectancy. However, if the control of health expenditure is merely limited to preventing patients from being reimbursed, the objectives of the health system are not met. In the United States, the privatisation of health insurance has paradoxically led to an increase in public spending. Among the solutions put forward are the reorganisation of access to health care; a review of the status of private doctors; the provision of continued education programmes for doctors by the caisse nationale d'assurance maladie (CNAM : French national health insurance department); and a wider-based decision-making body handling the reimbursement of the costs of various medicines in order to cope with pressure from the pharmaceutical industry.