FRANCE

Demographics
Population: 66.3 million with 2.1 million in Overseas departments (January 2015).
Live births per year: 820 000 births per year for 556 000 deaths per year (2015).
Percentage of population under 15 years: 18.66% (2015).
Ethnicity: French (91.1%).
Language: French.
Other Language: Arabic, Portuguese, Spanish, and Chinese.
Life expectancy at birth: Men: 79 years; Women: 85 years. (One year in 20 years’ women life expectancy).

Healthcare system
Type: The French healthcare system named Social Security (SS) is substantial health cover for all workers including persons assisted with a welfare system. Patients are free to choose their physician and paramedic practitioner usually within the region. In public Hospitals, consultation costs are 2/3 covered and surgery costs are fully covered by SS except private practitioner costs. In private clinics or medical office, patient pays and is reimbursed later by SS and private insurance (if subscribed). Patient can choose a practitioner with medical costs similar to public cost or practitioner with free honorarium. Private insurance subscribed by the employer or the patient, covers extra costs.
Cost to patient to see a primary care doctor/ general practitioner : 25 euros (7.5 euros is covered by private insurance subscribed or is to be paid by the patient). However many practitioners have more expensive costs that must be paid by the patient or a good private insurance.
Cost to patient of squint surgery under general anesthesia : In public set-ups, the cost is 1200 euros including outdoor surgery costs. These costs are covered by Social Security. Patients have to pay 25 euros for every day that they spend at the hospital. If they have private insurance, the insurance company reimburses them. In private practice, extra costs may be applicable & might be partially or completely covered by private insurance.

Paediatric ophthalmology :
Around 150 paediatric ophthalmologists and strabismus specialists (for 5500 ophthalmologists in France) with two national societies included in the French Ophthalmologic Society.

Major successes:

1. Fourteen University Orthoptic Departments located in all territory with doubled number of students in 10 years. Around 3500 orthoptists are practicing in France.
2.  Visual screening by paediatricians, general practitioners or maternal and children protection at two months old, four months old, nine months old and 24 months old. Visual screening at kinder garden when children are 3 or 4 years old.
3.  Rare Diseases Centres accredited by French Health Ministry. Six Centres are dedicated to ophthalmologic rare diseases.
4.  Optometry not recognized as a visual paramedic profession.
5. Genetic research and innovative healthcare institute “Imagine” at Paris Necker specialized in rare diseases with ocular research component.

Major challenges:

1. Visual screening must be improved.
2. Coordination of paediatric ophthalmologists must be improved.
3. Training programs for paediatric ophthalmologists has to be individualized.
4. Low general ophthalmologists and even more paediatric ophthalmologist to population ratio.
5. Extend orthoptists implantation for all the territory to improve visual screening in children