Patient access to physical therapy services/entry point
•In France, the physiotherapist masseur main mission is rehabilitation. They take into account the physical, psychological, social, economical, and cultural characteristics of the person being cared for at all ages of life. The physiotherapist draws up a balance sheet, within the framework of a medical prescription which includes a diagnosis and the objectives of care, as well as the choices of the acts and techniques for treatment which seem to be most appropriate. They work with patients of all ages and work both manually and with medical equipment.1 The profession includes the rehabilitation of almost all medical conditions.
.•Patients can access physical therapy in various settings such as hospitals, primary care centers, and private clinics. In France, visits to specialists including physiotherapists are only reimbursed by the health care system if the patient has been referred to the specialty by their own general practioner.2 Citizens may visit any health care specialist that they want, without getting referred by their general practitioner, but if they do so, then the reimbursement will be lower.
• Direct access to physical therapy is not permitted in France.
The physiotherapist must have good physical resistance in order to be able to handle patients of various body types. Good interpersonal skills are required as to educate, motivate, and encourage patients. In addition, they must be a good manager of time as to be able to organize him/her self to receive many patients throughout the workday.
•To become a physiotherapist in France, you must obtain a state diploma of masseur-physiotherapist.
•There are 40 or so training institutes for masseur physiotherapy, which train 2,700 young health professionals each year.5
•The degree is a bachelor’s degree
.•The first year is referred to as a “common” year.3 It is common for all medical studies, such as medicine, odontology, pharmacy, midwifery, and physiotherapy.3 Upon completion of the first common year, a competitive examination is given. The student’s results will determine which area they will be eligible to enroll in. Depending on their score, their own choice, and their rank in the first year determines the area of study. For physiotherapy, it is another 3 years after the one common year. Therefore, a total of 4 to attain the diploma. 3
•The physiotherapists attain a very detailed knowledge of human anatomy and its biomechanics. The field of knowledge extends to the respiratory, cardiovascular, musculoskeletal, and neurological systems. The studies focus on pathologies for all of these systems, their medical surgical and physiotherapy treatments and this is all in the field of both hospital and outpatient medicine.5
•Once a diploma is received, the physiotherapist can specialize in sports, pediatrics, respiratory, geriatrics etc. Another common specialization in France is to acquire additional training in osteopathy or chiropractic.4
•Federation Francaise des Masseurs Kinesitherapeutes Reeducateurs (Members: 4,600 (2013)
Information about patient community
•The vast majority of France's territory and the population is situated in Western Europe.
•In March of 2017, the population of France officially reached the 67 million mark.5
•Physiotherapists serve all different ages from infants to the geriatric population.
•The population in France is considered to be in good health. French consumers are satisfied with their health care system.8 They consult their doctors more often, are admitted to hospitals more often, and purchase more prescription drugs.8
•Physiotherapist serve the community for any of the following rehabilitation needs: massage, lymph drainage, respiratory care, sports rehabilitation, sensory motor rehabilitation, equilibrium disorders, neuromuscular disorders, disorders of the musculoskeletal system both traumatic and non traumatic, geriatric rehabilitation, cardiovascular rehabilitation, postural re-education, rehabilitation of burns, rheumatic diseases, postpartum care, preventative medicine etc.
•According to a ranking in 2016, the top five causes of mortality in France are as follows: ischemic heart disease, Alzheimer’s, cerebrovascular disease, lung cancer, and colorectal cancer.6
•Top five health problems that caused the most disability in France in 2016 are the following: low back and neck pain, organ disease, skin disease, depressive disorders, and migraines.6
•Top five risk factors that drive disability and death in France according to a census from 2016 are as follows: alcohol and drug use, tobacco, dietary risk, high blood pressure, and high body mass index. 6
•The French family dynamics are very close and supportive of one another.
•According to the family policies in France in 2014, public support is designed to alleviate the impact of children on the standard of living of households. 7 Growing concerns about issues such as employment, gender equality, and child poverty have progressively reshaped the scope and content of family policies aimed at helping parents reconcile work and family life.7
•The French are typically reserved and polite.7
•Most families are small, with only one or two children.
•Since single income is not enough to live on in most cities, it is common for both the husband and wife to work.7
•Most French people place a high priority on spending time with their family.7
•The French are among the most patriotic people in the world supporting their country and its principles. They are satisfied with their health care system and that it provides universal coverage.
Delivery of care
•Physiotherapy care in France is available in both the private and public setting. The French healthcare system provides healthcare to every resident in France regardless of age, income, or status.
Type of health system
•The French healthcare system is a national healthcare system with universal healthcare coverage largely financed by government national health insurance.8 The government has taken the responsibility of the financial and operational management of health insurance by setting premium levels related to income and determining the prices of goods and services refunded.8
•The universal healthcare system features a mix of public and private services, relatively high expenditure high patient success rates, low mortality rates, and high consumer satisfaction.5
•The French government generally refunds patients 70% of most health care costs and 100% in case of costly or long-term ailments. Healthcare absorbs a large proportion of the country’s gross domestic product relative to that of other countries.9
•Provision of health care is a national responsibility. The Ministry of Social Affairs, Health and Women’s rights is responsible for defining the national health strategy.10
•The Ministry of Health is a cabinet position in the government of France. They oversee the public services and the health insurance part of Social Security.
•In addition to setting national strategy, the responsibilities of the central government include allocating the budget expenditure among various sectors, hospitals, and regions.10
•At the regional level, the Administration of Health and Social Affairs is represented by the Regional Health Agencies, which are responsible for the health and health care of the population.10
•The global system (social security system) will cover 70% of the global cost unless you have a long duration medical problem such as cancer or diabetes where all expenses are covered at 100%.8
•In 2004, the system added the Carte Vitale smart card system.8 This card has all the information on the patient and the coinsurance company. The consumers need to designate a primary physician in order to obtain the full level of reimbursement. When you go to the doctor, you present your Carte Vitale and the amount of the state reimbursement is then credited back to your bank account directly.
WCPT Country Profile for France
The governing body of the masseur physiotherapist in France
Location of France
1.Federation hospital de France website. Available at: https://www.hopital.fr/Nos-metiers/Les-metiers-soignants/Masseur-kinesitherapeute. Accessed on November 1, 2017.
2.The French Healthcare system- Le Securite Sociale website. Available at: https://about-france.com/health-care.htm. Accessed on November 2, 2017.
3. University Paris Descartes website. Available at: https://www.univ-paris5.fr/eng. Accessed on October 31,2017.
4. Phosphore website. Available at: http://www.phosphore.com/metier/250/nom/masseur-kinesiotherapeute. Accessed on November 1,2017.
5.Kinesitherpie website. Available at: https://fr.wikipedia.org/wiki/Kin%C3%A9sith%C3%A9rapie Accessed on November 2,2017.
6.Institute for Health Metrics and Evaluation website. Available at: http://www.healthdata.org/fracnce. Accessed on October 30,2017.
7.Family Policy in France 2014 website. Available at: http://www.perfar.eu/policy/family-children/france. Accessed on November 2, 2017.
8. Taguri A, Nasef A. The French Health Care System; What Can We Learn? Libyan journal of medicine. 2008;3(4):186-191.
9. Steffen M. Universalism, Responsiveness, Sustainability- Regulating the French Health Care System. New England Journal of Medicine. 2016; 374:401-405
10. Rodwin V. The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States. American Journal of Public Health.2003;93(1):31-37.