CAIRN-INT.INFO : International Edition

The efficiency objective of the healthcare system and the necessity to deal with a locally lacking of medical healthcare suppliers (equity objective) has driven the initial model of practices’physicians to evolve. The implementation of a gatekeeper, the concentration of activity and experiments in sharing responsibilities characterise this trend and herald the advent of a new model for outpatient services, thus gradually calling into question the principles of the self-employed doctors’charter. Despite this strong trend, some rules from the old model have endured, notably with the practically exclusive conservation of fee-for-service and the freedom of establishment. Beginning with the “family doctor” reform, this contribution aims to analyse this transformation, the issues it highlights and also the associated contradictions. The impact of this reform on new forms of organisation, the tools for regulation and the territorial discrepancies in healthcare offers are analysed in relation to the latest demographic data.

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