[Organized screening of colorectal cancer in France. System of care and professional logistics].
The preservation or the amelioration of the health of individuals and populations does not only depend on the activity of the medical profession. It largely depends on public health policies. Screening for cancers illustrates how difficult it is to organise an action of public health within a health care system of liberal tradition in France. Through the example of screening for colorectal cancer, this article proposes to identify the mechanisms by which the system of health care determines the methods of organisation of mass cancer screenings. Through interviews carried out among the organisers of five colorectal cancer screening campaigns, we identified three models on which French screening campaigns are based: an administrative model, a medical model and a mixed model. Each of these models represents a different adaptation of the organisation of mass screening to the health care system in place in France. The interests of the concerned professional groups confront each other and the collective interest. It seems that to integrate such an approach to public health in a system dominated by payment per act is doomed to fail. Today, France can no longer avoid a modification of its health care system and of its nomenclature if it wants to improve the feasibility of cancer screening programmes and increase their chance of success.
Herbert
C
C
INSERM 96-03, Faculté de médecine, C.H.U. Côte de Nacre, Caen.
Launoy
G
G
D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D003695:Delivery of Health Care / Q000458:organization & administration*; D005602:France / Q000453:epidemiology; D006270:Health Facility Administrators / Q000523:psychology; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D017146:Models, Organizational; D015980:Public Health Practice; D011795:Surveys and Questionnaires