Occupational Therapy which was established in America according to Hussey, Sabonis-Chafee O’Brien (2007) on March 15, 1917; has become of international importance in the health science field. Occupational Therapy which has become international is important to France which lies between Italy and Spain in Western Europe. France has been an active member of the World Federation of Occupational Therapy since 1964 (WFOT, 2004). According to (COTEC 2009), there are 6,553 Occupational Therapists working to serve 63.8 million inhabitants of France (France-Diplomatie, 2008).
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France has a bicameral parliamentary system for a government, and also has a President and an appointed prime minister (France-Diplomatie, 2008) which is similar to the American President and Vice President. France is a prosperous country that also has national healthcare system, that it uses to supply its’ citizens with medical care. “France is the fifth largest economy in the world in terms of GDP – â‚¬ 1,792 billion in 2006” (France-Diplomatic, 2008).
Unfortunately France has a stressed National Healthcare plan, and as life expectancy grows in France, the burden is on France’s national government to find ways to find financial support, Sorum (2005). The democratic government has a universal healthcare plan that is primarily supported through health insurance funds and the social security system which pays for roughly 86% of the population according to Sorum (2005). Current legislation has changed the structure of the healthcare program. This legislation was a result of an upheaval in the medical field. Sorum (2005) p.237, “At the end of 2001, many generalists refused to do night or weekend call until their reimbursements were increased from 17.53 to 20 Euros for regular office visits, 30 Euros for home visits, and more for night office visits”. Legislation passed in 2003-2005 went into effect to answer many of the healthcare problems. According to Sorum (2005), a general increase in co-pays along with an increase in fees charged and an increase in taxes of the whole society served to please all parties and stabilize the struggling healthcare plan (p. 239). This action seemed to emulate some of the methods used by neighboring countries with similar plans and healthcare woes.
One would believe that with a universal healthcare program that healthcare would be client-oriented. Hutton Andral (2000) found though, that methods of treatment are prescribed according to reimbursement by society rather than cost to the patient.
The options for physicians on cost minimization strategies to reduce cost to the patient seem dependent on the one hand on the state of medical technologies and the pace of innovation in the therapeutic area and on the other hand on the type of de-listing or reimbursement policy followed by the government (Hutton Andral, 2000, pp.84)
This behavior results in a client-centered type environment that is guided by overall cost and reimbursement rather than what’s cost effective for the client.
Occupational Therapy in France would seem to benefit from a general increase in reimbursement for services; unfortunately the sheer disproportion of occupational therapists per capita also takes effect on the state of O.T. The low density amounts of O.T.’s per inhabitants causes more stress on occupational therapists as well as more focus on the clinical end of the practice. According to the Association Nationale Française des Ergothérapeutes (ANFE 2008)  “The density of Occupational Therapists in 2008 reached 11 per 100,000 inhabitants. The comparison with other professional always reveals a gross disproportion, hardly acceptable to the needs of the French population” (p. 11). Even though there is a large disparity among therapist to client ratio some contributions to OT are in the workings.
According to (ANFE 2008)  the top two recipients of O.T. resources in France are: rehabilitation of the adult establishment (25%) and geriatrics (20%). As “Baby Boomers” continue to retire and to live longer lives the geriatric portion looks to grow exponentially. ANFE 2008 (HID 1998-1999)  “76.9% of women over 60 report having a disability whereas 72.6% of men report the same. With this in mind the ANFE has enacted the 2008-2012 National Alzheimer’s Plan. For this purpose (WFOT 2004) “O.T. action is mostly attended in home-adaptations and cognitive rehabilitation” (Para 2). ANFE also plans to work with the French Association of OT in Geriatry (AFEG) to focus on interaction between different medical professionals (ANFE 2008) . To continue contributing to the field of occupational therapy worldwide ANFE has other goals, and according to WFOT (2004) they include: developing the publication of OT books on a national scale, designing a method to collect final dissertations for OT students, support research in OT, support creation of a new OT school, and creating “Ergoscope” a communications tool for O.T.’s for the 2008 / 2009 period (Para 4).
The development of an Alzheimer’s Plan is a very instrumental program / idea that could serve as a template for other countries. The other accomplishments France is striving for would help France catch up to the needs of its people as well as to other developed O.T. programs in other countries. These moves serve to improve O.T. in France and contribute more to the international file of O.T.
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To deal with the demands of a growing population an influx of qualified O.T.’s are needed. According to COTEC (2009) there are 1,050 student O.T.’s in France’s eight programs of occupational therapy (p. 4). The occupational therapy schools are under the jurisdiction of the Ministry of Health and Education. The current length of the O.T. program in France is 3 years according to COTEC (2009, p. 4). To graduate as an Occupational Therapist in France schooling is necessary where upon completion the graduate will receive a diploma for occupational therapy. This differs from other countries such as the United States where Occupational Therapist qualifications are reserved for Masters level graduates. International educational contributions are not fully established from France due to a language barrier problem and lack of an O.T. database to share research findings. In response to information asked about journal information about education and other contributing factors from France the following was recorded: S. Mehanneche (personal communication, February 18, 2010) “I’m sorry. All papers and documents are in French. There are very few French speaking English in France. Therefore there is no translation.” Attempts are being made to expound on the education portion of France’s O.T. program. Ergothérapie, the French O.T. database is receiving more journals and is aiming to become accessible worldwide. Along with Ergothérapie reaching for new boundaries, the ANFE also looks to become more accessible; if the Alzheimer’s Plan of 2008-2012 is deemed a success it could potentially provide countless methods and information on therapy for Alzheimer’s patients. From the information that has been discovered France is not at the forefront in education, France has several instrumental steps to make to be in a league as the American or Australian occupational therapy programs.
Research in France is also scarce due to the language barrier and lack of available information. Through what info that is available the French are working in three key areas. According to European Cooperation in Occupational Therapy Research and Occupational Science (ECOTROS 2010) there are three therapists from France that are interested in doing research cooperation projects. These researchers are Marie Chantal Morel, Hadj Kalfat, and Eric Sorita. The research topics according to (ECOTROS 2010) are: Marie Chantal Morel- O.T. / O.S. Theory philosophy focusing in professional education (p.20), Hadj Kalfat- Assessment methods and outcome measures / mental health for geriatrics (p. 16), and Eric Sorita- Community based treatment / O.T. interventions and neurological disorders (p.28). These therapists / researchers are important to France because they look to push forward and gain new knowledge or develop new techniques that will help push France forward in the field of O.T. Research and developments like these are important because they help eradicate obsolete or ineffective modes of treatment. According to the Lancet (2007) a treatment for autistic children with psychiatric problems in France is causing huge problems (p.645). According to the Lancet (2007):
The therapy, called packing, involves wrapping a child tightly in wet sheets that have been placed in the refrigerator for up to an hour. When children are encased in this damp cocoon-with only their head left free-psychiatrically trained staff talk to them about their feelings. (Spinney, 2007, pp.645)
This treatment is commonplace in France for autism despite a 1996 French National Consultative Ethics Committee for Health and Life Sciences report on the treatment. This report states Lancet (2007) “There was no evidence to substantiate psychoanalytic models of autism, nor that therapies based on this model were effective” (p. 645)
Pushing the issue on doing research will help erase non-effective therapies like this from the practice. Without substantial evidence to prove that a technique is insufficient mal-informed therapists will continue to do treatment like this that could potentially do more harm than good. For this reason, France needs to allocate more resources towards the research and evaluation of new methods and techniques, until then France will continually not be able to contribute much to the O.T. field internationally for research.
It has been concluded that through the information available and what was gained from practice, education, and research from France that France is not as advanced as could be. Programs such as the Alzheimer’s Plan of 2008-2012 are a step in the right direction towards advancement of clinical practice and could be very instrumental in the practice after studies are done and results calculated. A hindrance is the lack of communication when viable resources are available (i.e. internet various journals / databases), leads the reader to believe that the O.T. program in France has not had a big push to publish their information on international basis. This lack of effort in sharing information can only impede things such as research. In the (ECOTROS 2010) co-operational research this is demonstrated by the meager three representatives for the whole country of France compared to 27 from the United Kingdom, 24 from Germany, and 14 for the Netherlands. With a more conscientious effort to put forth and share quality work, France could become one of the leaders in the field of occupational therapy, when it comes to the realm of practice, education, and research.
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