Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

This study evaluated the costs of work-related stress in France. Three illnesses--cardiovascular diseases, depression, musculoskeletal diseases and back pain--that may result from exposure to stress are identified and the proportions of cases attributable to the risk factor are calculated from epidemiological studies. Two methodological hypotheses allow us to provide complementary evaluations of the social cost of occupational stress and raise the ethical questions inherent in the choice of methodology. For the year 2000 our model shows that of a working population of 23.53 million in France some 310,000-393,400 persons (1.3-1.7%) were affected by illnesses attributable to work-related stress, and that 2,300-3,600 persons died as a result of their illness. Work-related stress costs society between Euro 1,167 million and Euro 1,975 million in France, or 14.4-24.2% of the total spending of social security occupational illnesses and work injuries branch.

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Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.