France: More Action On Doctors' Spending

A series of decrees and regulations is due from the French government over the next three months, with four in particular expected to reinforce spending controls. The first concerns the organization of new economic forms of treatment, the second obliges doctors to undertake further training on a regular annual basis, the third addresses financial sanctions to be applied to doctors breaching target growth limits, and the fourth relates to the new health card.

The latter will authorize health funds to introduce the card across France. An initial paper version of the card goes out in October, with a magnetic card in 1999. Each patient will have to present the card at each consultation, except in emergencies. At present, non-presentation of the card will not be subject to sanctions eg non-reimbursement, but Georges Jolle, vice president of the major national health fund, the CNAM, says the card and its presentation should be compulsory.

CNAM In Talks With Doctors Meantime, the CNAM plans to cut 4.2 billion French francs ($817 million) worth of treatments and obsolete tests and procedures from its list of reimbursable treatments provided by doctors. CNAM president Jean-Marie Spaeth starts talks with the doctors in October on ways to effect fund reforms and spending controls; CNAM director-general Gerard Rameix said agreement on reform was essential as the economies were "only a palliative."