Total health expenditure represents 240 billion euros in France today or 12% of GDP, after 60 years of substantial growth. This upward trend is doubtless not going to end, even if recurrent attempts to moderate it manage to restrict, to some extent, the proportion of this expenditure that is covered –and socialized– by sickness insurance, at the risk, as Jean-Claude Angoulvant reminds us here, of thwarting its social objectives. The very notion of health and the practices associated with it have been transformed by technical and societal developments, as Professor André Khayat explains in this same issue.
If we carry this logic to its extremes, as the present article shows, the current organization of care and its funding could be transformed into a genuine system of health “production” (in addition to remedy and prevention), capable of incorporating the changes at work (linked in particular to the evolution of health “demand”, taken in an increasingly wide sense) and seeing us through a break with the old practices.
In this context, Jean-Claude Angoulvant sketches a broad systemic vision built around the “care pathway” –which should, in his view, become a “health pathway”. The idea involves bringing together the various strands of the “health-care machinery” –definition and content of health, practices and techniques, governance, regulation, funding etc.– and the related interconnections.
This work is conceived as an introduction to the necessary foresight approach to feed into a coherent public policy that covers all the fields concerned by future developments.