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HEALTH

How the health reforms will change life in France

French MPs gave the green light to a sweeping health reform bill on Tuesday that will bring some major changes to life in France. From a ban on ultra-skinny models to free visits to the doctors, here are the main points.

How the health reforms will change life in France
Smoking in cars with children in - one of the acts banend under France's new health reform that was adopted by parliament on Tuesday. Photo: Shutterstock

France's National Assembly voted through a raft of reforms on Tuesday after two weeks of often heated debate. 

The bill, presented by the health minister Marisol Touraine has provoked nationwide protests from doctors and criticism from French modelling agencies and tobacco companies.

Touraine's bill was adopted by the National Assembly by 311 votes to 241. It will now pass to the senate, before returning to lower house, before it officially becomes part of the law.

Here's the main points of how life in France will change:

Smoking crackdown: In an effort to take some of the glamour out of smoking, the colourful branding and well-known logos will be wiped off cigarette packs by 2016.  The crackdown on smoking also includes a ban on the the habit in cars with children in. Despite France’s reputation for healthy living, smoking is a major problem here and it’s tied to 73,000 deaths per year.

No more e-cigarettes at work: The electronic cigarette, which has proved highly popular in France will no longer be allowed in closed collective spaces like work as well in places where children are present like schools and public transport.

Clean rooms for drug users: The bill also includes introducing so-called "shooting galleries" or clean rooms for drug users in certain areas as part of trials. These are places where intravenous drug users would have access to clean needles, sanitized facilities and access to drug counselors. 

Binge drinking ban: If it is passed, people who encourage minors to drink excessively could face a year behind bars and a €15,000 fine. And anyone who incites others to “drink until drunk” could face up to six months in prison as well as a fine into the thousands.

Anorexia – Thanks to an amendment on a law public health voted on by MPs earlier this month, inciting anorexia will become a crime in France, carrying up to one year in prison and a fine of €10,000. The law is designed to take aim at so-called "pro-Ana" sites accused of encouraging excessive thinness. Up to an estimated 40,000 people suffer from anorexia in France, nine out of 10 of them women and girls. 
 
Skinny models to be banned- Under a similar amendment France will is to ban ultra-thin skinny models from catwalks. The move made headlines around the world. The aim, the Socialist deputies sponsoring the measures said, is to bring body ideals hawked to the public back to a healthy reality.
 
"Anyone whose body mass index… is below a certain level will not be able to work as a model," according to the amendment of the bill voted by the lawmakers. 
 
Tanning – Sunbeds will no longer be used by minors and must not be advertised. Those in charge of the machines must also be trained in the health risks triggered by exposure to UV rays.
 
Digital doctors records: France already has a system whereby patients’ records are supposed to be digitized, but it never really took off. So Touraine is giving it another try, this time putting the Assurance Maladie in charge of the initiative. Digital records are seen as the future for hospitals around the world and help doctors coordinate care, but also provide a means to keep patients informed and involved.
 
'Soda fountains': Another amendment added to the bill by deputies will see a ban brought in on unlimited refills of soft drinks from soda fountains. The move is aimed at tackling obesity. 

Payment-free doctors visits: The bill would end the current system that sees patients cover part of the cost of a doctor’s visit. It would come into effect for special cases by 2015 and by 2017 for everyone. The idea is to better prevent illness, which is less costly and produces better results than trying to treat a problem that’s long gone unchecked.

Abortion rule changes: The reform aims to get rid of the seven-day "cool-off period" for getting an abortion, which is in place to allow patients a chance to change their mind. Women must currently wait a week between two medical consultations in order to be allowed an abortion. In emergency cases, for example if the woman is approaching her 12th week of pregnancy, this seven-day period can be reduced to 48 hours. 

Organ donation register: The new reforms say that people should have to sign up to NOT be on the organ donor list. France currently works on a system of assumed consent, but if the reform gets through, French people will have to sign a national registry saying they don't want their organs donated to circumvent this. It would come into place in 2018.
 
Cancer survivors' right to be forgotten: Touraine's reforms say that anyone in France who is 100 percent cured from cancer has the right to have their medical record "forgotten". This means that when they're applying for jobs or requesting loans, they can avoid any potential forms of discrimination.

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HEALTH

When can doctors in Denmark refuse to continue treating patients?

General Practitioners in Denmark have the right to break off a patient-doctor relationship in specific circumstances.

When can doctors in Denmark refuse to continue treating patients?

Although doctors in Denmark have the right to decide not to continue treating a patient – requiring them to find a new GP – the circumstances in which this can happen are limited, and must be approved by health authorities.

The frequency in which the circumstances arise is also low. A doctor decided to no longer receive a patient on 375 occasions in 2016, according to the medical professionals’ journal Ugeskrift for Læger. The following year, newspaper Jyllands-Posten reported the figure at 458.

There are two main categories of circumstances in which a doctor can choose to take this step. The first is in instances of violent or threatening behaviour from the patient towards the doctor. 

The second (and most common) is when the doctor considers the relationship to have deteriorated to the extent that confidence has broken down, according to Ugeskrift for Læger.

It should be noted that patients are not bound by any restrictions in this regard, and can decide to change their GP without having to give any justification.

A patient also has the right to appeal against a doctor’s decision to ask them to find a new GP. This is done by appealing to the local health authority, called a Region in the Danish health system.

In such cases, a board at the regional health authority will assess the claim and if it finds in favour of the patient may order the doctor to attempt to repair the relationship.

Doctors cannot end a relationship with a patient purely because a patient has made a complaint about them to health authorities. This is because patients should have the option of making complaints without fear of consequences for their future treatment. 

However, if this is accompanied by the conclusion on the doctor’s part that there is no longer confidence in them on the part of the patient, they can remove the patient from their list.

The right to no longer see patients in the circumstances detailed above is provided by doctors’ collective bargaining agreements, the working conditions agreed on between trade unions and employer confederations under the Danish labour market system.

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