France’s parliament has voted in wide-ranging reforms aimed at improving public health and cutting public spending on health services.
Among the long list of reforms is the introduction of plain packaging for cigarettes, a crackdown on the use of overly thin models in the fashion industry and measures to curb underage drinking, child obesity and the use of sunbeds in people aged under 18.
The measures – proposed by Health Minister Marisol Touraine – also include another attempt to introduce digital health records as well as changes in the payment system that will do away with patients handing over a co-pay upfront for consultations.
Doctors will instead be reimbursed through public or private health insurance policies, and the government says this will encourage people on low incomes to seek treatment for illnesses in good time.
The reimbursement changes have prompted strikes and demonstrations by healthcare workers, with a group representing independent physicians – the Syndicat des Médecins Libéraux (SML) – declaring its “total opposition to…third-party payment and more broadly to Marisol Touraine’s draconian health proposals.”
The SML’s president Éric Henry has called for withdrawal of the bill pending a health conference to discuss reforms and promised additional protest action in the coming weeks “to defend the future of our profession.” The changes will leave doctors out of pocket, they allege.
If the reforms go through as they are, France will become only the second country after Australia to mandate plain packaging for tobacco products, although moves are afoot to enact similar legislation in the UK.
The government also wants a ban on the use of electronic cigarettes in public places – including workplaces – as well as restricted advertising for these products that are seen as a gateway into smoking for young people.
The intention is to strip the glamour out of smoking and make health warnings more prominent in a bid to cut the number of smokers in France – currently numbered at 13 million and said to be growing – by 10% within five years.
Tobacco companies are already fighting back, however, arguing that the measures will breach trade and intellectual property (IP) laws and also make it easier for counterfeiters to infiltrate the supply chain.
Proposals to prevent the glamorisation of excessive body thinness centre around making incitement of anorexia a crime punishable by up to one year in prison and a fine of €10,000, while anyone with a body mass index (BMI) below a certain threshold will be unable to work as a model.
The reforms were passed by 311 votes to 241 in the National Assembly earlier this week but still need to be considered by the Senate before they can come into force.
However, under the French legislative system the Assembly has the last word on legislative proposals so even if they ware watered down or rejected by the Senate could still come onto the statute.
France healthcare spend was 11.8% of its GDP in 2012, compared to the UK spend of around 10% in the same year.