All indicators show higher mortality rates in the northern part of France (from Brittany in the west to Alsace in the east), and in regions located on an axis from the north east to Auvergne in the centre of the country. Along this axis, the higher rates of mortality concern all causes of death, whereas in the west (Brittany and Normandy) risk factors such as alcohol consumption explain some of the higher mortality. Alcohol and tobacco use are not independent of socioeconomic status and are often higher in poorer regions affected by high rates of unemployment, etc.
The main causes of death in France are cardiovascular disease (31. 1 % of deaths), cancer (27. 7%), accidents (8. 3%) and diseases of the respiratory system (8. 1%) (Sandier Paris & Polton, 2004). Policy and Regulation: Jurisdiction in terms of health policy and regulation of the health care system is divided between: • The state: parliament, the government and various ministries • The statutory health insurance funds • To a lesser extent, local communities, particularly at the department level.
Every year since 1996, the parliament has passed an Act on Social Security Funding based on the reports of the Accounts Commission (Cour des Comptes) and the National Health Conference. This act sets a projected target (ceiling) for health insurance spending for the following year, known as the national ceiling for health insurance expenditure, approves a report on trends in policy for health and social security and contains new provisions concerning benefits and regulation (Sandier Paris & Polton, 2004).
The Ministry of Health, which has recently been reorganized, includes a general directorate of health, responsible for health policy, a directorate of hospital and health care, responsible for the management of resources (its scope, previously limited to hospitals, has been extended to the whole health care system), a directorate of social security (responsible for financial matters, and for supervising social security organizations) and a general directorate for social policy, which is responsible for the specifically social aspects of health care (such as care for disabled, elderly or vulnerable people).
The Ministry of Health controls a large part of the regulation of health care expenditure, on the basis of the overall framework established by parliament.
It is responsible for dividing the budgeted expenditure between the different sectors (and, where hospitals are concerned, between the different regions) and policy matters such as deciding on the number of medical students to be admitted to medical school each year, the number of hospital beds and the amount of equipment, approving the agreements signed between the health insurance funds and the unions representing self-employed health care professionals, setting the prices of specific medical procedures and drugs on the basis of proposals from ad hoc committees and establishing safety standards in hospitals (Sandier Paris & Polton, 2004).