FRANCE
From the survey • The majority of the respondents reported encountering no difficulties obtaining their medicines and medical devices. o The few stock issues reported appeared to have limited impact on people’s treatment, and these problems were usually resolved within a few days. o On the other hand, it seems that a small portion of people with diabetes still face affordability issues, despite the existing scheme, which offers free access to healthcare and treatment for people with a chronic disease. • Diabetes education and information about treatment were provided almost universally among the people with diabetes surveyed but was far less frequent among their relatives. • The low number of respondents with types of diabetes other than type 1 diabetes makes it difficult to discuss access for all people with diabetes.
Healthcare expenditure profile (2011)2
Key background information: country health system
23%
Total health expenditure per capita: USD 4,952 Proportion of government expenditure on health: 15.9%
Health system overview
Public expenditure Private expenditure Out-of-pocket expenditure represents 32.1% of private spending on health
77%
- The National Health Insurance System, administered by the National Union of Health Insurance Funds, covers the whole population.3 - The French National Authority for Health develops recommendations for the Ministry Of Health and the National Union of Health Insurance to define the care package.3 - Medicines and medical devices are supplied principally by private actors, according to the Ministry of Health regulations – in line with EU regulations. A specialised agency ensures that these regulations are applied.3,4,5 - A quality issues reporting system is in place.5,6 However, further to recent scandals revealing the system’s weaknesses, it is being reformed.6
Diabetes prevalence1
Key diabetes data
IDF Atlas
National Data
7.3% of 20-79 year-olds (2011)
Official records: 4.4% (Prevalence of people with diabetes receiving care, 2009)
Diabetes care procedure
- Prescriptions are provided mainly by GPs and, to a lesser extent, diabetologists, who tend to focus on more complex cases.6 - These doctors, along with associations and pharmacists, are the main points of diabetes information and advice.6 - Most diabetes supplies are dispensed at pharmacies, except for insulin pumps, which are dispensed by specific contractors.5,6,9
Presence of products at national level
• At least one product from each of the categories surveyed appeared to be authorised for sale and was present in the country.1,5
Availability
Guidelines and specific prescription criteria
• France has guidelines for diabetes care.1 • Insulin pumps have to be prescribed in a specialist prescribing centre (hospital), which also undertakes patient education.6,9 o Pump therapy can be offered to people on insulin under certain conditions: those who are failing to achieve good control of their diabetes despite intensive insulin therapy; pregnant women; children; people with complications; people whose lifestyle constraints make diabetes management difficult under regular insulin therapy. The person’s level of motivation is also taken into consideration.6,9 • The French National Authority for Health recommends that newer medications should be used mainly as second- or third-line treatment.6 Certain medications to treat hypoglycaemia, such as glucagon, are mainly prescribed to people treated with insulin.6 • However, decisions concerning the prescription of diabetes supplies are left to the prescriber’s assessment of each individual’s conditions and needs.6
Use
56
• The responses collected suggest that most people treated with insulin, and especially people with type 1 diabetes, are using insulin analogues and insulin pens.5 • The use of insulin pump therapy is quite high compared to other European countries.10 However, pumps are far more common among children than adults and their uptake is quite recent.6,10 Additionally, the use of pump therapy varies widely from one prescribing centre to another.10 • Metformin is the first-line oral medication6 and is the most widely prescribed.5