On a background of tense negotiations for a workable Brexit deal, President Emmanuel Macron announced a health reform for France, which stands health as a pillar for his 21st century welfare state. Macron's “health transformation strategy” aims to be the most ambitious reform in 60 years, a “change in paradigm” that puts the patient at the centre of care and focuses on better prevention, care for non-communicable diseases, and translational care.

The plan relies on 54 measures, which include the creation of 400 jobs for general practitioners who will have a shared activity between their practice and the hospital. 4000 medical assistants, a new type of health professional created for this reform, will be rolled out by 2022. They will do simple medical procedures, assist patients in their path through the medical system, and take charge of some administrative tasks. Over the next 3 years, the system will also invest in its digital services, aimed at creating a unique digital file for each patient. The plan also includes an educational reform, with an end to the cap on the number of medical students that can enrol each year.

At a time when the President's approval ratings have fallen, critics note the uncontentious nature of this reform, with its marked social slant acting to counter-balance Macron's industry-friendly stance. Questions remain as to how using incentivisation to encourage physicians to work in rural areas with poor coverage and the proposed restructuring of hospital care to a three-tiered system—proximity care, specialised care, and so-called ultra-specialised care—are feasibly going to be implemented.

If it lives up to its expectations, this reform could be formidable; the combination of Health Minister Agnès Buzyn's medical experience with Macron's vanguard enterprise might be just what is needed to transform political will into a concrete overhaul. But more to the point, this reform sends a strong message on the international stage. In a time of increased economic and political uncertainty, by positioning himself steadfastly on the side of the foundation of France's social contract—the provision of health as a human right—Macron shows that France stands by its fundamental principles.

the Lancet's France: nation and world Series see Forsee https://www.thelancet.com/series/france-nation-and-world

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