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Martinique Healthcare

A 1992 law provides that all persons residing in France and in French Departments have the right to financial assistance for medical treatment costs in case of need. Access to medical attention for the poor is organised by the Department in which they live. The Department pays either the entire cost or the "ticket moderateur", which is a portion ranging from 0% to 65% depending on the nature of the illness, the care provided, or the type of medication. The costs of care to the homeless are paid by the State.

Health insurance is provided by the social security system, a State-sponsored mechanism financed with compulsory contributions from salaries. The patient pays the total cost of treatment directly to the health provider and is later reimbursed by a health insurance agency. Reimbursement amounts are negotiated by healthcare providers and the social security system. A growing proportion of the population voluntarily takes out additional insurance to finance non-reimbursable portions. A system of direct payment by insurers relieves the patient from having to advance the cost, particularly for hospital and drug costs. In these cases, the health insurance system pays directly to the healthcare provider and the patient contributes the "ticket moderateur".

The State has responsibility for general public health, including community-wide disease prevention, sanitation surveillance, border health control, and the control of major diseases and drug and alcohol addiction. The State oversees training of health personnel, helps define their conditions of work, monitors observance of quality-control regulations and health safety in treatment centres, and regulates pharmaceutical products. Moreover, it supervises the adequacy of treatment and preventive arrangements and regulates the volume of treatment provided. The central Government oversees the functioning of public hospitals, appoints their directors, establishes their budgets, and organises their staff recruitment. Finally, the State supervises social welfare, its financing, the rules for population coverage, and financial responsibility for treatment.
A prefect manages the State decentralised services corresponding to each of the Ministries involved, particularly those relating to health issues. At the local level, other prefects manage a Health and Social Affairs Office and the Interregional Social Security Office, common to the three departments and with a central seat in Martinique.

Under the 1983 decentralisation law, certain State medical and social responsibilities were transferred to the Presidents of the General Councils in each Department. These include: maternal and child welfare, immunisation, tuberculosis control, sexually transmitted diseases (excluding AIDS), cancer, leprosy, child social welfare, and part of the assistance to the elderly and to disabled adults. The mayors may have certain responsibilities for sanitation and immunisation, and chair the boards of directors of public health establishments.

Residents of the French Departments enjoy unrestricted access to a wide range of primary and secondary medical services in France. In 1991, the University Hospitals and Regional Cancer Control Centres in France provided 61,000 hospital days to 4,500 patients from the French Departments, which represent an estimated 3% of hospital operation in Martinique, respectively. More than 25% of those days were for treatment of cancer patients, followed by patients suffering from cardiovascular disorders and genitourinary diseases. The social security system reimburses hospital expenses, but pays airfares for only a small proportion of patients requiring medical treatment not available in the Departments.

Public and private hospitals provide full hospitalisation, ambulatory treatment, and outpatient consultations. Inpatient care is divided into short-term treatment (acute conditions), follow-up (convalescence, re-adaptation, and functional rehabilitation), and long-term care (designed essentially for the elderly). Private practitioners provide most ambulatory or home care, although patients may also avail themselves of outpatient services at hospitals or treatment centres.

The public and private sectors differ in some regards. Teaching and research are part of the specific missions of the public hospitals. They are obliged to accept all patients and employ only salaried staff. Physicians in private hospitals charge fees.

Since 1985, public establishments have been financed primarily through a grant made by the State on an annual basis and paid by the health insurance scheme. Private establishments are funded through lump-sum payments and daily rates fixed by the regional health insurance offices. Their funding is thus proportionate to their activity, which is not the case for public hospitals.

The regional health organisation plan in Martinique includes an "emergency" and "resuscitation" section. It comprises three public hospitals (including one teaching hospital), and three private clinics.

The public sector offers 1,831 beds for short-term hospitalisation, 114 beds for follow-up and functional rehabilitation, and 101 beds for medium-term care. The private sector provides 100 beds for short-term care, 39 for follow-up and functional rehabilitation, and 61 for medium-term care. Specialities are provided in all categories and offer a full range of treatment.

Ambulatory care provided includes home dialysis, alcohol and cancer control centres, and a multiple-addiction centre. Emergency medical care is given special attention in the regional health organisation plan. The current organisation has established a hotline centre ("Centre 15") accessed through a single toll-free emergency telephone number. This centre provides appropriate care, from physician care to helicopter transportation and specialised medical care. Emergency calls made to "Centre 15" are serviced by an emergency unit at Fort-de-France Teaching Hospital and three emergency units at public hospitals.

A system of municipal hospitals is available to provide intoxication and hepatitis C therapy, which strengthens the coordination among hospital doctors and private practitioners. There are also HIV infection information and healthcare centres.

Blood transfusion units operate nationally under the French Blood Agency. Regionally, a physician monitors proper blood-transfusion practices.

There are 25 private and 8 public biomedical labs in Martinique. The prefect may authorise the operation of private laboratories taking into account local conditions, personnel qualifications and available equipments. The public labs are part of the hospitals.





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