FRANCE

From Big Medical Encyclopedia

FRANCE, the French republic — the state in Western Europe; borders on Belgium, Luxembourg, Germany, Switzerland, Italy, Spain. The area is 551,6 thousand sq.km, the population apprx. 54 million people (1983). The capital — Paris (2,2 million, with suburbs more than 9,6 million zhit.). Administrative division — 96 departments. Ofits. language — French.

On Page and 3. the countries are located extensive lowlands, on Yu.-V. — the French Alps (reaching the greatest height in an array Mont Blanc, 4807 m). On extreme Yu.-Z. the Pyrenees were stretched. Climate sea moderate, on V. transitional to continental; on the coast of the Mediterranean Sea — subtropical, Mediterranean.

T. — bourgeois parliamentary republic. Its structure, except the mother country, includes overseas departments Guadeloupe (see), Martinique (see), Guiana (see French Guiana), Reunion (with - m), Saint Pierre and Miquelon, overseas territories —

islands New Caledonia, French Polynesia, etc. the Highest legislature belongs to the parliament consisting of 2 chambers: national assembly and senate. The head of state is the president elected for 7 years. You govern l s-tvo formally responsibly before parliament, but actually iodchinyaets I to the president.

T. — advanced industri-and l no-and of p and r N and I with t r and on, z and Nym of a yushch I on gross national product and industrial output the fourth place in the capitalist world (after the USA, Japan, Germany). Feature of economy — high extent of development state monop about l is tiches to go a pi-talizm with a crucial role of the private capital. In 1982 the most considerable series of measures in the history of the country for nationalization is carried out: 36 largest banks, 2 finance companies, and also 9 large industrial monopolies are nationalized. T. has in a crust, time the largest among the capitalist countries of the West public sector of economy. In agriculture the large capitalist enterprises dominate. Agriculture where the leading role is played production of vegetables and fruit, winemaking is highly developed.

In the 80th years in the country a number of progressive social and economic transformations is carried out that is connected with activity of the communist ministers participating in the government together with socialists. However these measures, many from to-rykh are accepted at the initiative of communist ministers, could not suspend development of social and economic crisis in the country. For the last 8 years the number of the unemployed increased by 4 times and reached 2 million people (9% of economically active population) in 1983. Adhering in general to the general with the USA, Great Britain, Germany and Japan of strategy in the relations with socialist and developing countries, T. at the same time has clearly the expressed identity in a formulation of specific goals of the policy and the choice of methods of their achievement.

The number of economically active population in 1980 made 23,2 million people (43,2%). Inflow of labor from abroad is considerable; at his expense in 50 — the 60th the need for unqualified work was satisfied. St. 90% of the population — French. Apprx. 2 million people (together with families of 4,5 million) — the foreigners immigrating to the country in job searches (Algerians, Portuguese, Italians, Spaniards). Population density apprx. 98 people on 1 sq.km (1983). The main demogra-

Incidence. In the country it is not carried out constant registration of diseases. Materials of annual statistics and results of special researches give an idea only of the most common forms of pathology.

Data on causes of death, additional — data of cash desks of social insurance, and also data

on incidence among hospitalized are the main source of information on incidence of the population. Regular registration of patients in out-patient conditions is carried out in cash desks of social insurance at terms netrudospo-


sobnost more than 6 months that allows to judge only incidence of chronic and serious illnesses.

The main reasons for death — about l e zn with is subjects of blood circulation, malignant new growths, accidents, poisonings and injuries. In structure of mortality of men the essential place is taken by the causes of death connected with alcohol intake, alcoholic psychoses and cirrhosis, especially in the Regions of Brittany in the North and the northeast of the country. Acute respiratory diseases and diseases of digestive organs are most widespread. It is tended to growth mental and stomatol. diseases. The largest specific weight among diseases, at to-rykh is required hospitalization of patients, have injuries, diseases of digestive organs and breath. Cardiovascular diseases stand in this row on the fourth place though as the reason of negotiability to out-patient clinics they win first place.


Venereal diseases are eurysynusic. The strengthened fight against them after World War I soldiers led to considerable decrease in incidence, but World War II caused new flash. The actual number of patients with venereal diseases considerably exceeds official data since the majority them is treated at private medical practitioners, to-rye do not report to bodies of health care about the patients though the law of December 31, 1942 predii-with yvat an obligatory tion of all venereal diseases of the register in the infectious period. and the law of July 8, 1948 — obligatory

fichesky processes reflect the tendencies characteristic of the majority of the countries of the European continent. Data on the natural movement of the population of the country from 1901 to 1981 are presented in tab. 1.

Reduction of a natural increase of the population (4,6 for 1000 of the population in 1981) against the background of decline in mortality at the beginning of the 80th it is not compensated by increase in birth rate. In age structure of the population in 1980 persons are more senior than 60 years made 17%. The average duration of the forthcoming life in 1980 made for women 79,1 years, for men — 70,8 years.


hospitalization and treatment forcibly persons, from it evading. Treatment in veins. clinics and relevant departments of BC free. Under the law of the person, going to marry, are obliged to undergo medical inspection with tselyo exceptions of venereal diseases and tuberculosis; is obligatory also to medicine which inspection of all pregnant women. In 1948 the regulation

of i of r wasps to Tit Tion is cancelled, z ap also at personal houses are solved.

Since 1937 in all departments of the country clinics on a psychohygiene are open, 80% of maintenance costs to-rykh since 1955 are incured by the state. The number mentally sick, however, is big and grows every year.

Social it is insured and e in F. is a gain of working class. The law on social insurance was adopted in 1946 when the government included communists. There are several systems of social insurance. The largest — the general system including insurance on a case of a disease (since January, 1978 it captured all population), old-age insurance and family grants. There is also a system of insurance working on hiring in agriculture (18% of the population) and special systems (5% of the population), including for workers and employees National about-va the railroads of France, merchant marine fleet, miners, professional soldiers, kre-styan-owners, dealers, handicraftsmen and persons of liberal professions.

Social insurance on a case of a disease for the persons working on hiring and equated to them is financed insured and employers. For January 1, 1971 the contribution for insurance on a case of a disease, pregnancy, disability and death in the general system made 15,95% of the salary, from to-rykh 3,5% it was the share of the worker and 12,45% — of the employer. From an insurance premium of 30% it is spent for medicines, a lab. analyses and optics, 25% for the fees to doctors, 20% make expenses on hospitalization. A certain working experience is provided in the general system for obtaining the right for a grant. The state practically does not take part in financing of the general system of social insurance on a case of a disease, paying only 2% of collecting. In other systems the share of its participation is slightly higher.

At visit of the doctor, receipt in-tsu or receiving other types of medical aid of the patient pays all cost of services, and then the insurance company compensates to it the sum determined by the agreement. The general system provides a full recovery of costs of medical aid in cases of hospitalization, duration exceeds a cut 30 days, and also at certain nosological forms and groups of diseases. The list includes them tuberculosis, a leprosy, venereal diseases, poliomyelitis and its residual phenomena, a sarcoidosis, malignant tumors, diabetes at children, hemophilia, malignant anemia, mental diseases, defeats of vessels of a brain, Parkinson's disease, a myocardial infarction, hron. nephrite, nephrosis and nek-ry others. Insured do not participate in expenses on medical aid also at approach of disability and in case of accidents on transport. Payment of temporary disability to insured begins from the 4th day of a disease. To a grant on disability the increase on children is provided in nek-ry systems of social insurance. Special systems of social insurance provide insured big privileges, than the general system, but in the presence of more long working experience.

Responsibility of businessmen for the accidents which happened at work in connection with work and on the way to work is established by the law. Each industrial enterprise (it belongs also to transport) is obliged to have service of occupational health. Its tasks purely preventive: medical survey at revenues to work, periodic surveys of workers and surveys before their return after a disease, first-aid treatment and supervision of hygiene of working and production rooms.

The service of medical aid aged at home, created at the beginning of the 70th, provides the services to persons 60 years are more senior, provides rehabilitation actions after an extract from hospital, etc. Such medical aid through the general system of social insurance is paid. The law of January 2, 1978 provided measures for increase in the minimum size of old-age pensions, increase in grants having many children, etc.

In 1977 merging of all services responsible for questions of the state health care and social security or having relation to them was complete, the independent Ministry of Health and for a family is created.

Medical care. Medical aid to the population F. the general practitioners and specialists working individually or in the conditions of group practice render; the clinics which are under authority of municipalities about-in the mutual credit, the trade-union and philanthropic organizations; hospitals (state and private).

Hospital help is given in hospitals of the general profile and specialized (tab. 2). Hospitals of the general profile subdivide into three categories: local (rural)-tsy power apprx. 40 beds; the general-tsy (to 1000 beds); wedge,-tsy with educational and research base. In addition, depending on function would distinguish short-term stay (for patients with acute forms of diseases),-tsy long-term stay, hospital of rehabilitation, etc.

Special network of the centers for fight against poisonings jointly with services of emergency medical service and a toksi-stake. provides with departments of BC

acute medical aid at poisonings. The patients needing the emergency help in would be brought most often transport of police. Recently the tendency to creation instead of large insane hospitals of small departments in-tsakh the general type is noted.

In 1960 for the purpose of approach of the hospital help to country people are created local (rural)-tsy. In them there are therapeutic and maternity departments, and also a shelter for people of senile age. These would become the link of hospital network, closest to the population. Dignity. their state of disrepair, number of rural doctors for various reasons constantly decreases. The general shortage of beds in shelters and nursing homes caused inflow of persons of senile age and hron. patients in rural-tsy that changed their initial appointment.

In 1970 the law on reform of BC which founded the public hospital service was adopted. The law was an important step forward in the organization of health care F., however reform is carried out slowly. The public hospital service is urged to provide the population with all types of the stationary help, to promote preparation and improvement of doctors, scientific research in the field of medicine and pharmacy. The law approved the sanitary map of the country determining borders of districts and sites by rendering the hospital help. This card forms a basis for planning of construction new and expansions of old BCs, more uniform providing districts with hospital beds. For opening of private clinics it has to be granted permission, proceeding from needs of the district.

Still apprx. 30% of hospital beds belong to the private sector, to-ry it was assumed in the country with the reservation that its work will be coordinate with activity of the public hospital service. In practice this situation is not carried out. Private clinics began to be guided by the paid types of medical aid and hospitalization of the patients who are not demanding long stay in a hospital (obstetric aid, operational surgery, etc.), providing thereby a high turn of beds and the guaranteed income to the owner-tsy. In the state hospitals hospitalize the patients having the heavy and chronically proceeding diseases, at to-rykh prolonged and expensive treatment is necessary.

In public sector of health care there is not enough BC, and in them personnel, especially nurses, allocations are insufficient. Many would decay (37,8% are constructed till 1900, 22% — between 1900 and 1945).

Since January, 1982 elimination of the private sector in the public hospital service is begun that is connected with coming to power of the new government with participation of communists. This measure caused furious con a rotivleniye of private medical practitioners, to-rye were initiators of creation of the «Medical solidarity» trying to resist to attempts of the government «to break integrity of a health system».

In N e about l the N and and about e about with l and in and N and e the population are carried out h by generally private medical practitioners having the agreement with bodies of social insurance. For the last decade in F. the group practice combining doctors of both one, and various specialties gained considerable distribution.

Most BC has no polyclinic departments. Moreover, the ambulatory care is even formally separated from stationary. But at nek-ry state the general type polyclinic departments (offices) of various profiles giving to the population extra hospital help would function. This type of the help is provided with also multi-profile centers of health which are under authority of municipalities where the payment for consultation is established.

Specialized extra hospital to lay down. - prof. the help render the state clinics signing, as a rule, agreements with bodies of social insurance. Clinics inspect the citizens addressing them and in case of detection of a disease carry out treatment. Psikhonevrol. clinics provide out-patient treatment mentally sick, and also the persons having alcoholism and drug addiction. All anticarcinogenic centers have hospitals, hold consultations in the cities attached to them where doctors of these centers leave. The largest medical p the rofilaktichesky and scientific anticarcinogenic center — Ying t of Gustave of Russia in Vulzhyuif. Antitubercular clinics are engaged in prevention of tuberculosis, identification and the accounting of patients.

Sanitarno - epidemiological service is based in the activity on the law adopted

still on February 15, 1902. According to this law all projects of construction of dwellings, water supply, the sewerage etc. shall be approved local a dignity. bodies. In 1946 the law regulating activity of laboratories for chemical, bacterial was adopted. and other researches, to-rye shall be in each department. The decree of May 20, 1955 in Paris created National laboratory of health care.

Fight with inf. by diseases it is organized in scales of departments. It is established compulsory vaccination against tetanus, diphtheria, poliomyelitis and tuberculosis, and for certain categories of professional workers, napr, personnel of BC — also against a typhoid and a paratyphoid. Services of school hygiene provide medical overseeing by the children visiting preschool institutions, elementary and high school and also for teachers (preventive actions concerning students of the higher school enter competence of the Ministry of Education).

And p techny business. Advanced pharmaceutical industry of France is hl. obr. in hands of the largest monopolies. T. wins first place in the world by quantity of the consumed medicines. The release of patent means requires permission of the Ministry of Health and for a family; it is possible to patent only the name of medicine, but not its structure. In F. there is a control system behind the prices of pharmaceutical products. The prices are approved on the basis of settlement cost value taking into account the cost of raw materials, margins on packaging, scientific research, advertizing and overhead costs. However the profit of monopoly can be hidden in originally declared cost of chemical raw materials or become covered by intra-corporate operations.

In recent years are planned nationalization of three major pharmaceutical companies («Roussel — Uc-laf», «Rhone — Poulenc» and «Pechiney») and cooperation between Ying volume of Pasteur, the Center of hemotransfusion and Ying volume Mierye. Further development of the program of regulation of consumption of pharmaceuticals and development a wedge, pharmacology, creation of the Supreme council on drugs are assumed.

Sanatorium help. Many resorts F. got world fame. It is promoted by favorable seaside climate, abundance of mineral sources and therapeutic muds. Development of resorts began in the middle of 17 century. In a crust, time among balneol. resorts are most known to Vichy (see), JIa-Burbul (see Jiaburbul) where there are sources of gidrokarbonatno-sodium mineral waters (see); Bourbon-Lansi in department of Seine with thermal sources weak hloridno-nat-riyevykh the waters containing iodine and arsenic; Dax in department of Landes; Vittel (see) and Plombyer-le-Ben in department the Vosges with sources of carbonic and calcium waters and sources of the thermal highly radioactive waters containing nitrogen; ferruterous hloridno - sodium sources of Ex-le-bin, etc. On the coast of the Atlantic Ocean there are seaside climatic resorts of Saint-Jean-de-L a skid, Arkashon, Biarritz (see), Saint-Tropez, Saint-Rafïel in department the Pitch. Summer bathings on the coast of English Channel-Burke-surrealism-measures are popular ((((((((((see) with beaches for children, Dieppe, Saint-Malo, Truvil, etc. In French riviera (Kot-d'azyur) of the Mediterranean Sea there are glorified seaside resorts of Nice (see), Cannes (see), Menthone (see) with a year-round climatotherapy, sea bathings, children's beaches. Mud resorts are renowned: Dax, Saint-Aman, Balaryuk - le-Ben with to lay down. dirt of various

ii r about is x about deniye.

Treatment in resorts is generally carried out for a payment chastnopraktikuyu-

by shchy doctors. In 1947 in F. acts for providing a dignity are adopted. - hens. insured and disabled veterans, the Crimea the known privileges are established by the help. Treatment in climatic resorts of the children having bone tuberculosis

and in balneological resorts — children with effects of poliomyelitis is widely applied.

By efforts of French balneal about-va in Paris at College de France in 1914 it was created National in-t of a hydrology and climatology, Krom possesses an important role in studying and promoting of resort richness of the country. Under the leadership of the famous physicist Zh.-A. D'Arsonvalia in resorts F. it was organized St. 30 bioclimatic stations and the observation posts where a climatophysiology, klimatopatolog and meteorologists made joint observations and researches. Works National in-that a hydrology and climatology, a number of departments Lyons and other high fur boots nominated the French medical climatology to the leading positions in the world.

Medical education. In recent years as a result of reforms medical education in F. underwent considerable changes. Training of doctors is carried out 33 medical faculties of universities. Duration of training is 7 years:

The I cycle — 2 years (training in fundamental sciences), the II cycle —

4 years (1 year of preclinical preparation and 3 years of a training in-tse as an ex-sloe), the III cycle —

1 year (a training in-tse as the intern). Further the young doctor can come on a competition to an internship (4 years of training) or to specialize on the chosen specialty on average within 3 years. Courses of specialization will organize medical f-you and labor unions of doctors. The training provided in the course of specialization is held to a wedge, the hospitals and hospitals having on this special permission.

Dentists are trained by 16 dental surgery schools, duration of study in to-rykh 5 years. Nurses study at 96 schools, the term of their preparation in 1972 is increased up to 3 years. Midwifes are trained by 49 schools. Annually graduate from schools of St. 10 thousand diplomaed nurses and more than 400 midwifes.

In 1981 2 new decrees concerning medical education in are issued to-rykh rules of receipt in an internship or residency are in detail stated. The persons who worked within 5 years practical doctors are allowed to these types of preparation. The status of residents and interns is almost identical, their salary would be defined by the budget. Improvement of the diplomaed doctors in F. has no uniform system and depends on a personal initiative and financial opportunities of the doctor.

In 1977 in the country there were 91 442 doctors (17,2 on 10 000 inhabitants), 27 683 stomatologists, 33 510 druggists, 21 300 assistants and assistants to druggists, 31 676 physiotherapists, 6391 logopedists, 1000 hearing aids specialists, 152 575 diplomaed nurses, 8899 midwifes, etc.


Medical science. T., having long scientific traditions, gave to medicine a number of brilliant doctors-thinkers, innovators and reformers. The huge merit in development of surgery belongs to A. Paré (16 century). At the end of 18 and the beginning

of 19 century the group of great scientists — M. Bisha, F. Pinel, Zh. Kor-vizar, R. Laennek worked. The major role the organizations of hospital business was played by P. Kabanis. In 19 — 20 centuries such scientists as F. Ma-zhandi, M. Flurans, K. Bernard, L. Pasteur, 0 worked. Ru. J.-A. d'Arson-

Wal, F. Vidal, Zh. Sharko, A. La-veran. P. Curie, A. Kaljmett, A. Labori, A. Lakassan, R. L of a ruff, G. Ramone, etc. Especially it should be noted close connection of the French medical science at the end of 19 and in 20 century with Russian and Soviet.

One of the leading principles of national policy in development of science is preferential providing basic researches; in their financing the significant role belongs to the state.

Medico-biol. researches are conducted National in-volume of health care and medical researches, Ying volume of Pasteur and Ying volume of radium, and also high fur boots and the National center of scientific research. Committee but coordination medico-biol. researches it was created in 1967 as a part of representatives of ministerial institutions and the interested groups under the chairmanship of the general delegate on a scientific and technical research and under jurisdiction of the minister but to researches.


Table 1

the NATURAL MOVEMENT of the POPULATION of FRANCE from 1901 to 1981


 


The Table 2 DISTRIBUTION of HOSPITALS AND BED FUND TO FRANCE in 197 7 g (according to WHO data, 1 98 3)



the Bibliography: Year-book of world sanitary statistics 1979, Geneva, 1983; Health care of foreign countries, under the editorship of O. P. Shchepin, M., 1981; The Organization

of medical researches in France, under the editorship of Yu. P. Lisitsyn, M., 1979; Health services in Europe, t. 2, Copenhagen, WHO, 1983; The Countries and the people, Foreign Europe, Western Europe, under the editorship of 10. V. Bromley, page 103, M., 1975; France, under the editorship of G. G. Diligensky and V. I. Kuznetsov, M., 1982; The sixth

review of a condition of health care in the world of 1973 — 1977, the p. 2, page 366, Geneva, WHO, 1981; Cliabrun-Robert C. L'evaluation de la qualite des soins en

of m£decine hnspitaliere, Coneours med., t. 103, p. 1331, 1981; Dumont J.

e t L a t, o u with h e J. L’hospitalisation malade du profi I, P., 1977; P of e s s at R. Bilan demograiiliique aeiuei de la France, Coneours med., t. 102, p. 2123, 1980;

World health statistics annual 1984. Geneva, 1984.

Lake of II. Shchepin, L. I. Vladimirova.

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