French doctors threaten strike over health reform

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The Independent Online
French GPs and specialists are up in arms and threatening a strike later this month in protest against proposed reforms to the health service that will directly affect the way they work.

The reforms, which emphasise spending targets and quality control and resemble in many ways the highly contested NHS reforms in Britain, are part of the comprehensive overhaul of the welfare system announced by the French government last year to curb spiralling costs.

The proposals are framed in two draft ordinances - measures designed to be rushed through parliament with minimal debate - and relate to doctors on the one hand, and to the running of hospitals on the other. In a neat piece of political timing, the ordinances were conveyed to doctors' and hospital representatives over the Easter weekend, making it difficult for them to mobilise an immediate response.

Leaders of the biggest doctors' association, the Confederation of French Medical Unions, were nonetheless so incensed that they have already called a strike for 24 April, the day on which the French Cabinet is to finalise the provisions.

One reason for the doctors' anger is their apparent failure to have the threat of financial sanctions removed. When the health and welfare reforms were first announced last autumn, the Prime Minister, Alain Juppe, mooted the possibility of freezing fees or docking money from doctors who exceeded state-set spending targets.

Through the weeks of public-service strikes, which were directed primarily against proposed changes to the social security and pension system, the doctors were quiet. Behind the scenes, they were conducting an intense lobbying campaign, which they believed to have been successful. The draft ordinance on doctors' practice shows, however, that the proposed sanctions have, if anything, been toughened.

Doctors will face a freeze on their fees if they exceed the annual spending target - this year set at an increase of 2.1 per cent over last year. In addition, individual doctors face the prospect of returning to the health insurance companies the amount they are deemed to have overspent. The howls of anguish were immediate

The proposed hospital reform includes the creation of regional health agencies to negotiate contracts between the state and medical insurance companies on the one hand and the hospitals on the other. The contracts will contain requirements for quality of care, as well as budgetary stipulations.

It is unclear whether the government's tougher stance on health reform is a bargaining tactic designed to leave room for big concessions in the event of serious protest, or whether it is final. The doctors, however, fear the worst. They cite a recent estimate by the economy minister, Jean Arthuis, that the health and social security budget could overspent by more than twice the estimated 17bn francs. Although Mr Arthuis's deputy described the figure as "random", doctors fear they might have to pick up the tab.