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An audit of the French national health insurance system would be justified by economic considerations alone, but this would risk overlooking the notions of solidarity and freedom to which the French are rightly attached. European comparisons suggest, however, that our system could be made more efficient without undermining public health. The national health insurance system allows each member of the population to receive high-quality medical care. Practitioners have near-total freedom of prescription and practice. Medical care contributes to the ongoing increase in life expectancy, which is currently 73 years and second only to Japan. Healthcare is also a source of a million jobs. Macro-economic spending controls have failed, owing to medical progress and population aging, and also to medical consumerism favored by an unprecedented range of examinations and treatments, the increasing reimbursement of medical care, and the extension of direct payment by the insurer. Many ineffective measures have been implemented, such as tarification according to activity, and hospital certification. Health spending is also increased unnecessarily by bureaucratisation of healthcare spending and the transfer of professionals to posts for which they are not qualified. Some controversial medical prescriptions are not adequately controlled by the health service. Many reforms are based on over-optimistic economic predictions that fail to take related overheads into account. Lobbying by special interests groups undermines reform and the public interest. Too many independent administrative bodies have been created, and many are less efficient than the public structures they replaced. In sum, the French national health insurance system has become less and less efficient over the years.

Established in law on August 13th, 2004, the personal medical records system was intended to ensure better treatment at lower cost, notably by avoiding redundant examinations and incompatible treatments. The system should have been implemented on January 1st, 2007, for all people with medical insurance coverage. Various difficulties, and particularly problems of confidentiality, led to successive postponements. Six years after its creation, the shared medical records system is still not operational. This article examines the theory and the reality, and concludes that fundamental changes must be made to what was an over-ambitious project. Practical and cheaper solutions exist, and would allow the creation of secure individual medical records acceptable to the medical profession and public alike.