France has been, to this day, famous for its healthcare system and a long-running tradition of hospitality. When someone goes abroad, one of the most usual uncertainties that one has is how good the healthcare system really is, especially when talking about dentistry where hygiene is a key factor. So, given this question that most of us have to go through, let’s delve deep in the healthcare system and the history behind it.
France is a wellspring of medical innovations. Countless teams of doctors and researchers are trained under the most rigorous of standards, which is why they are responsible for some of the world’s most important and impressive discoveries in a wide range of therapeutic fields. People all over the world decide to go to France in other to treat a disease in a reliable manner. Access to French healthcare is now much easier, with a facilitated health visa process, improved hosting conditions for patients and their families, tailored services and specially trained staff available if needed. Patients who do not have access to the care they need in their home countries can now receive the medical treatment and care they need, one which meets their quality, cost, and hospitality expectations. This is why the French health care system is considered of universal health care.
The French health care system is largely financed by the government national health insurance. The World Health Organization found, in its 2000 assessments of world health care systems, that France provided one of, if not the best health care in the world. In 2011, France spent 11.6% of GDP (Gross Domestic Products) on health care, a figure much higher in comparison to other countries in the European Union, however less than in the United States. Approximately 77% of health expenditures are covered by government funded agencies.
Most general physicians are in private practice but draw their income from the public insurance funds, and these have never gained self-management responsibility. Instead, the government has taken responsibility for the management of health insurance. The French government generally refunds patients most health care costs, or in some special cases all of it. Supplemental coverage may be bought from private insurers, most of them non-profit, mutual insurers. Until the 2000s, coverage was restricted to those who contributed to social security, excluding the lower or poor class of the population; the government of Lionel Jospin put into place the previously mentioned universal health coverage and extended the it to all those legally resident in France.
The history of Frances health quality dates back to a long time ago, and it is necessary to understand their history before jumping right into dentist ( Geoallo urgence dentaire ). In 1289, the University of Montpellier is founded, which medical school becomes prominent and famous for putting forward the theory that the Black Death is caused by a miasma entering through the body’s pores when they open. This theory was based on the ones developed by Aelius Galen, a physician, psychologist and philosopher during the Roman Empire. Doctors educated at Montpellier advocated against bathing because the claimed that it opened the body’s pores, making one more susceptible to the bubonic plague.
Jumping to 1443, the Hospices de Beaune was founded as a hospital for the poor. It was a former charitable almshouse in Beaune, France, by Nicolas Rolin, the chancellor of Burgundy. The original building is now a museum, being one of the finest examples of French fifteen-century architecture. Services for patients are now provided in more modern buildings.
Like these, many other hospitals, institutes and organizations were founded up until this day. During the French Third Republic, from 1871 to 1914, they followed well behind Bismarckian Germany, as well as Great Britain, in developing welfare state including public health. Tuberculosis was the most dreaded disease of the day due to its likeliness to strike the youth below their 20s. Germany set up vigorous measures of public hygiene and public sanatoria, but France decided to let private physicians handle the problem, which in consequence, left them with a higher death rate. The French medical had a clear bias towards private health activists rather than public ones, and as a result they were not as well organized as in other countries like Germany, Great Britain or the United States. A law created to register infectious diseases, to mandate quarantines, and to improve the deficient health and housing legislation started a battle from 1880 to 1902 in order to be approved. It faced the opposition of bureaucrats, politicians and physicians, due to the law threating so many interests, so it was debated and postponed for 22 years. Success finally came when the government realized that contagious diseases had a national security impact in weakening military recruits, and keeping the population rate growth well below the estimated average in comparison to other countries like Germany.
Since its foundation in 1945, the current system that one can enjoy nowadays has undergone several changes, despite the basis of the system remaining as planned and operating. Jean de Kervasdoué, a health economist, believes that French medicine’s quality is of top notch, and is ‘the only true alternative to the Americanization of world medicine’. According to Kervasdoué, France’s surgeons, clinicians, psychiatrist, its emergency care system and others specialists that may or may not fall under the category of doctor (dentist being the case) are an example to the world. In contrast to this, he criticizes the fact that hospitals have to comply with 43 bodies of regulation and the nit-picking bureaucracy that is typical of the system. Kervasdoué believes that the state has too much intervention in the regulation of the daily functions of French hospitals. As a side note, Japan, Sweden and the Netherlands have health care systems with comparable performance to that of France’s, yet spend no more than 8% of their GDP.
Then, in 1960, the ADF (Association Denture Françai) was founded. The ADF has, since its beginnings, been the driving force behind the development of the dental profession. The history of the ADF is intertwined with the development of the dental profession and the emergence of its specific identity. Up until the sixties, at least in France, dentistry was not considered a discipline in its own right, but just a mere particular specialisation of medicine, particularly with regards to qualifying degrees. A new approach to dentistry has since emerged through the tremendous effort of professional associations to underline the unity and specificity of the dental profession. The Creation of the French Dental Association was at the very heart of this movement, and the ADF has played a key role in subsequent developments ever since.
But what is the ADF you might be asking? The ADF is a federation of 25 professional associations that cover the full range of the dental profession. It provides dentistry practitioners with a wide range of services, including continuing professional educational programmes, publications to keep abreast of new technologies and improve the work environment, product certification and a bibliographic database. The ADF not only represents the French dental profession inside the country, but also internationally. Each year, the ADF organises an Annual Dental Meeting, a major event which combines a Conference and an International Exhibition.
In order to understand the history of dentistry in France, we have to follow the progress of the ADF, due to, like it was stated before, it having represented the dental profession both nationally and internationally since its beginnings. That is why I believe the best way to present this progress is in a time-line like manner.
In 1968, eight years after the foundation of the ADF, at the general assembly of the dental profession, 800 representatives from various professional organisations draw up a charter stating the claims and rights of the dental profession. In fact, the ADF is created as a direct consequence of this founding statement. Two years later, in 1970, 21 national professional associations sign the French Dental Association charter in Paris. The ADF is officially established. Independent dental faculties are created that same year. The following year, 1971, it is the creation of a qualifying diploma in dentistry, the first in a series of university degrees. The Public Health Code is, therefore, updated, recognising the specificity of the dental profession.
In 1972, the first of many ADF annual dental meetings is held. At the meeting, one can find exhibitions of dental treatments, as well as news on the field and a lot of professionals ready to instruct anyone interested in the basics.
The dentofacial Orthopaedics speciality is created in 1977. This speciality involves prevention, diagnosis and correction of the malocclusion, neuromuscular and skeletal abnormalities.
The World Dental Congress is held in Paris for the first time in 1979. That same year is when dental surgeries start turning to computerisation.
In 1980, the very first ever communication campaign to promote the image of the dental profession is made. And two years later, in 1982, the ADF becomes the government approved certifying authority for dental products, instruments and equipment.
The table salt fluoridation is implemented in 1986 and the use of sugar substitutes in food products is authorised.
The National university degree in oral surgery and the CNFPO (Comité National de la Formation Permanente Odontologique), the national committee for continuing professional education in dentistry are created in 1991. The following year, 1992, the hospital internships in dental surgery is created. Dental studies experience a curricular reform, with a new six-year course leading to a post-graduate qualifying diploma. The creation of the COME (Centre Odontologique de Médicométrie er d’Évaluations), the scientific organization in charge of evaluating dental practices and their effectiveness happens two years later in 1994. The ADF initiates a quality approach project for the entire dental profession in 1995. It is also publicized the ICSII survey on dental healthcare in France conducted in the framework of the World Health Organisation international research programme.
The ADF publishes a set of 72 recommendations on hygiene and asepsis in the dental surgery in 1996 and in the next year, 1997, the ADF launches its own website, providing the dental profession with a regularly updated communication and exchange tool.
In 1998 the ADF seminar on good dental practice leads to the identification of the main issues to be addressed in the quality approach programme. The seminar is referred to as ‘the quality of oral care and oral health, quality control, the implementation of quality control, and its costs.’
The creation of the IFRO (Institut Français pour la Recherche Odontologique), which is the organism in charge of promoting and supporting dental research in France, is created in 1999.
In the year 2000, the ADF, the Conseil National de l’Ordre des Chirurgiens Dentistes (the regulatory body for dentistry in France) and the Committee of Deans of the French dental faculties sign an agreement setting the framework for continuing professional education in dentistry. The ADF and the FDI (World Dental Federation) jointly organise the 2000 World Dental Congress in Paris.
The ADF publishes six recommendations for dental practice, and designs a self-assessment tool (brochure, CD Rom, website) in 2001. The ADF Annual Meeting website is launched. The CNFCO (Conseil National de la Formation Continue Odontologique), whose mission is to organise and regulate continuing professional education in dentistry, is created.
Three years later, in 2004, the ADF and the HAS (Haute Autorité de Santé or French National Authority for Health) sign a cooperation agreement, aimed at promoting the quality of dental care. Two years later, in 2006, new rules for the validation of training credits are implemented by the CNFCO.
Jumping to 2009, the ADF and the Conseil National de l’Ordre des Chirurgiens-dentistes launch the first institutional campaign designed to enhance the image of dentists among the general public, the media and decision-makers. The ADF broadcasts the first JT de l’ADF (a one hour-long internet TV programme on dental news and topics).
These events in history are the main ones that marked the field of dentistry, and reshaped it in the way we know and enjoy it today. The ADF earned being referred to as the force behind the development of the dental profession.