Central level

The central government is responsible for:

•  The overall legislation;
• General policy guidelines and objectives (following pluri-annual objectives);
• The definition of health policy objectives, plans, actions and programmes;
• The evaluation of health policy;
• The regulation of financial and legal aspects related to the public health insurance system;
• Health education and research;
• Prevention;
• Protection Universelle Maladie – an improved universal healthcare system for legal residents, as part of the 2016 Social Security Budget;
• Social affairs and women rights;
• Allocating budgeted expenditure among different sectors (hospitals, ambulatory care, mental health care, social and health sector for the disabled among the different regions;
• Deciding on the number of medical students to be admitted to medical school each year, number of hospital beds and mount of heavy medical equipment including expensive medical technologies;
• Setting the prices of drugs and devices on the basis of proposals from the National Health Authority;
• Safety standards in hospitals.

Regional and intermediate

France's Regional Health Agencies (ARS) are morally and financially autonomous public institutions under the supervision of the central Ministry of Social Affairs and Health. The authorities are responsible for:

• Health surveillance, safety, and identification;
• Anticipation, preparation and management of health crises in liaison with the prefect;
• The definition of specific regional objectives relating to public health and implementation of the corresponding regional actions;
• Regional health supply regulation including meeting the supply of medicines in cities;
• Ambulatory care sector services.
• Health and social care for the elderly and disabled. Specifically, regional agencies coordinate activities and allocate operating budgets to hospitals, clinics, care centres, and structures for the elderly, disabled and dependent;
• Hospital sector services;
• The participation in the funding and building of sanitary facilities, on an experimental basis;
• Vaccination, fighting against tuberculosis, leprosy, HIV and sexually transmitted diseases (in cooperation with the State) on a voluntary basis;
• Regional agencies work on a  territorial dimension by distributing doctors and the provision of care optimally across the territory;
• ARS likewise work on an economic dimension by efficiently allocating resources and controlling health expenditure;
• Legislatively, the ARS has various levers of authorisation including the autonomous establishment of health and social care institutions and services, controlling fully their allocation of resources;
• Additionally, the ARS work with the National Solidarity Fund (CNSA) to define and implement actions to prevent and manage health insurance risk in the regions;Finally, regional authorities promote and evaluate the quality of training programs for health professionals in their territories.

Intermediate level

Departmental authorities are responsible for:

• Sanitary protection for families and children;
• The participation in the implementation of health programmes (within the frame of State/Department agreements)
• Activities of vaccination, fighting against tuberculosis, leprosy, HIV and sexually transmitted diseases (in cooperation with the State) on a voluntary basis. 
• Protection of children, through management of PMI centres which offer consultations and free health care.Possibility of building or subsidizing the construction of sanitary public infrastructures and facilities (especially in mountain areas) in order to maintain services
• Duty of health alert
• Departmental laboratories of analysis
• ARS are represented in each department by departmental delegation that locally accepts or declines regional health strategies

Local ​

Municipal authorities are responsible for:

• Hygiene and health municipal services;
• Vaccination, fighting against tuberculosis, leprosy, HIV and sexually transmitted diseases (in cooperation with the State) on a voluntary basis.

Responsible ministries/bodies

Ministry of Solidarity and Health

Sources

France, WHO, Health Policy Report, 2015

Social Security Financing Act, 2016

Code de la Santé publique [Code of Public Health], Articles L1411-1 to L1418-8, L1422-1, L1423-1, L1423-2, L1424-1, L1431-1 to L1431-4, L2112-1 to L2112-10.

Code de la Sécurité sociale [Social security Code], Articles LO111-3 to LO111-10-2. 

Code général des collectivités territoriales [General code of Local Authorities], Article L4221-1. 

Regional Health Agency: What is a Regional Health Agency?

Regional Health Agency: The National Steering Council

 [1] The "Numeros clausus" has been cancelled.  The number of students in the different specialities will be decided in concertation between State, universities and stakeholders. See : https://www.sciencesetavenir.fr/politique/medecine-fin-du-numerus-clausus-a-la-rentree-2020_134207