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The French Labor law defines the role and its allocation criteria of the occupational physician (OP) the same as in Japan. In France, occupational medicine is one of the medical specialties. The OP resident must follow the 4 years clinical training before certification. After having finished their residency, they are entitled to work for the occupational health service office of a company or company association (in the case of small and medium sized companies). The most important characteristics of the French system is that they cover all workers regardless of company size. The main role of the OP is prevention of work related diseases and accidents. They are not allowed to do clinical services except for emergency cases. Their main activities are health examinations, health education, patrol and advice for better working condition. Formerly, it was rather difficult to attract the medical students for OP resident course because of its prevention oriented characteristics. A growing concern about the importance of health management at the work site, however, has changed the situation. Now, the number of candidates for OP resident course is increasing. Their task has expanded to cover mental health and other life style related diseases. The 2011 modification of law redefines the role of the OP as a director of an occupational health service office who has a total responsibility of multidisciplinary services. The French and Japanese occupational health systems have many of similarities. A comparative study by researchers of UOEH is expected to yield useful information.

The basic principle of Diagnosis Related Groups (DRG) is to classify patients according to the combination of diagnosis and procedures. The first DRG developed by research at Yale University was adopted for the per-case-payment American Medicare scheme for hospital fees under a DRG/PPS (prospective payment system). This scheme has been refined continuously and adopted as payment systems in other countries. The DPC-based reimbursement scheme in Japan consists of two components; a DPC component and a Fee-For-Service (FFS) component. The DPC component corresponds to the "so-called" hospital fee, includes the hospital basic charge, the pharmaceuticals and supplies used in wards, lab-test, radiological examination, and any procedures costing less than 10,000 yen. The FFS component corresponds to the charges for surgical procedures, pharmaceuticals and supplies used in operation rooms, and procedures costing more than 10,000 yen. For the DPC component, a per diem payment schedule is set for each DPC group. One of the most important objectives in introducing the DPC scheme is to ameliorate the transparency of hospital activities in Japan. The DPC system is expected to make hospital services measurable, and then to provide a common ground for discussion among interest groups over the optimal policy to maintain a sustainable Japanese medical care system. However, in order to keep DPC more reliable, much must be done to refine the DPC version 3. For example, development of CCP (Co-morbidity-Complication-Procedure) matrix is now ongoing to more properly describe the resource consumption of each DPC group. It is also important how to evaluate nursing services, ICU services and expensive drugs and materials within the DPC sheme.

The French health care system is characterized by its social insurance scheme with universal coverage, freedom of prescription and of location by the doctor, fee-for-service payment by patients, and free choice of doctor by patients, which essentially tends to inflate its health expenditures. Thus, the health expenditures of France has been increasing over the average expenditures of other European countries. Under the principle of autonomy of the social insurance fund, the increase in medical expenditures has been absorbed by a decrease in the reimbursement rate and an increase in the contribution rate of the insured. However, it is no longer possible to cope with this financial crisis by these traditional measures because of the worsening of the unemployment problem. Nowadays, the increase in the contribution rate is regarded as one of the important reasons for the economic stagnation of the French society. In order to cope with this difficult situation, the French government has changed its health policy from the demand side strategy to the supply side strategy. The concrete plan of this policy was presented by Prime Minister Alain Juppé (the Juppé plan). The plan consists of; 1) unification of the medical insurance scheme, 2) establishment of a ceiling on medical expenditures, 3) regionalization of health policy, 4) disclosure of medical information, 5) introduction of medical references, 6) creation of a social protection scheme for the dependent elderly, 7) introduction of an object tax for the social security fund, etc. These subjects have been materializing step by step after many twists and turn. The most important principles of the plan are the transparency of the medical information and the responsibility of each actor within the health system. The French government has conducted a lot of international comparable studies of health systems. According to the results of a series of active and profound discussions, the French government has conducted various social experiments. It is very meaningful for the Japanese government to analyze this process of health reform occurring in France in order to discuss the health system reforms in Japan.