Reports by Delano D’Souza detail the French government’s multiyear endeavor to bring the healthcare industry back to life. Furthermore, even if they are making progress, the French Ministry of Labor, Health, and Solidarity still has a long way to go before they can declare victory. FRANCE 24’s Genie Godula is joined by Dr. Philippe Amouyel, a physician, professor of public health at the University Hospital of Lille, and director of the Alzheimer’s Foundation, for a more thorough examination and a more comprehensive viewpoint on France’s failing healthcare system.
Persistent issues
The 1999 Universal Health care Act (CMU Act) established the foundation of the French health system, which offers health care to all lawful inhabitants (Allonie, Dourgnon & Rochereau, 2006; Chevreul et al., 2010). SHI made up 73.8% of health spending in 2008; the remaining percentages were from VHI (13.5%), taxes (5.1%), and OOP payments (6.8%) (WHO, 2014). National health spending accounted for 11.1% of GDP in the same year. Through the regional health agencies (Agences Régionales de Santé, ARS), regions are playing a bigger role in the delivery of health care even if the Ministry of Health is still in charge of overall health sector planning and policy direction.
The 2009 Hospital, Patients, Health and Territories Act, which merged seven regional organizations in charge of public health, private self-employment, health and social care for the aged and disabled, and hospitals, gave rise to these agencies in 2010. By enhancing coordination between ambulatory and hospital care as well as health and social care services, the ARS can better satisfy the requirements of the public while adhering to national health budget targets (Chevreul et al., 2010).
Leadership instability
In line with national or regional aims, the ARS creates regional strategic health plans, or plan stratégique régional de santé, or PSRS, which outline the development objectives for regional care over a five-year period. Coordinating inpatient and outpatient care as well as health and social services for the aged and disabled in response to population requirements is the primary goal of the PSRS. In hospitals and ambulatory care settings, health services are provided by both public and private providers. The majority of general practitioners (GPs) are self-employed and engage in private practice; around 75% also work in hospitals or health institutions. Fee-for-service arrangements govern the payment of general practitioners and specialists. Covered SHI fees are determined nationally through agreements between professional associations and SHI. About half of individuals seeking medical attention are concerned about extra-billing on top of these prices. Physicians working in public hospitals are paid for their services.
Rebuilding the system
A number of health care changes have been implemented during the 1990s due to concerns about the lack of continuity and coordination of care within the healthcare system. Since 1996, the Social Security Financing Act, or SSFA, has established an annual national cap on SHI spending. The National Health Conference, which speaks for all parties involved, and the General Accounting Office (Cour des comptes) have both provided reports on which it based its conclusion (Durand-Zaleski & Obrecht, 2008; Chevreul et al., 2010).
The 1996 reform also included provisions to encourage provider network pilot projects at the local level to improve care coordination and continuity. The 2002 Patients’ Rights and Quality of Care Act (Président de la République Française, 2002) formalized these provider networks, or réseaux de santé, with the goal of enhancing the coordination, continuity, and interdisciplinarity of health care delivery, with an emphasis on particular population groups, disorders, or activities. Simultaneously, the SSFA for 2002 established provider networks-specific funds.
Importance of stable leadership
The 2004 Health Insurance Act outlined steps to enhance the long-term illness (affections de longue durée, ALD) program (see below). This act also refreshed SHI’s organizational and administrative responsibilities. In the ambulatory care sector, the law also instituted a type of gatekeeping known as the Médécin Traitant Preferred Doctor Scheme, which imposes higher co-payments on patients who seek care outside of this coordinated care pathway. It also established the Haut Autorité de Santé (HAUTE Autorité de Santé, HAS), which was tasked with creating guidelines for the management of chronic illnesses and defining the requirements for eligibility for the ALD system, among other things (Durand-Zaleski & Obrecht, 2008).
Path forward
A number of significant measures for the treatment of chronic diseases were included in the 2009 Hospital, Patients, Health and Territories Act (Chevreul et al., 2010). Initially, agreements on care procedures between experts were to be formed through contracts, and the transfer of work between specialists was legalized outside of the purview of trials. Second, the financial and legal position of multidisciplinary and multiprofessional care centers was defined by streamlining the legislation governing them.
