---

“The future challenges facing the French health care system are underscored by the measures planned for the 2015 Health Reform Law: on the one hand, improvements in the organization of care to meet the needs of an ageing, increasingly chronically ill population while combating inequalities through improved efficiency and equity in financing and geographic access; and on the other hand, the reform of long-term care to preserve the autonomy of elderly individuals and facilitate ageing at home while reducing the financial and care burdens on families.”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.

---

“The French health system still relies mainly on activity-based payments (fee-for-services for doctor consultations and diagnostic-related group payments for hospital services). While these payment methods create incentives to increase the quantity of care provided, they do not necessarily promote care coordination or reward quality and appropriateness.

“Recent government proposals are designed to experiment new payment methods in primary care and hospital to better respond to the growing burden of chronic diseases by providing greater financial incentives for care coordination and quality and giving less weight to activity-based payments. Starting in 2020, a selection of hospitals will test replacing the current activity-based payment system for hip and knee replacement and colectomy with an episode-based bundled payment system. Similarly, some primary care centres will be paid on a capitation basis and incentives towards local care integration will also be introduced. All these initiatives draw from international best practices.”

Source: OECD/European Observatory on Health Systems and Policies (2019), France: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

---

“The so-called medical deserts have been a priority on the political agenda for over two decades. However, because French physicians have freedom of settlement, it is challenging to address this issue. Coercive measures were considered but abandoned because of the significant political power of doctors, and financial incentives have been generally unsuccessful. Government reform efforts have shifted to multidisciplinary practice models, task transfer and the use of information technologies such as tele-health as means of compensating for lower physician density, particularly in rural areas. Moreover, promising initiatives focusing on improving the workplace quality of life of doctors have flourished at the local level.”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.

---

“The first part of a two-step plan to address loss of autonomy (projet de loi relatif à l’adaptation de la société au vieillissement) is expected to be enacted by the end of 2015 and to be operational by mid-2016. The first step focuses on measures designed to facilitate ageing in place, with the key measure consisting of increased ceilings and reduced individual financial participation under the APA (see section 3.6) to pay for assistance at home for an estimated 700 000 dependent frail elderly individuals. Other provisions of the proposed law include financing of measures to prevent and delay the loss of autonomy; adaptation of housing options, from new technologies for automation in private homes to modernization of nonmedical collective housing facilities, renamed autonomy residences (résidences autonomie; see section 5.8.1); and respite assistance for caregivers. These measures will be financed by CASA (enacted in 2013 as described above), which is estimated to raise €645 million per year. However, most of the 2013 and 2014 revenues raised were not kept for the reform but channelled to cover deficits in an unrelated social security programme. Starting in 2015, the CASA revenues should be fully dedicated to financing the autonomy reform.

“The second step of the reform will focus on institutional care, in particular reducing OOP payments for nursing home residents. Once more, the most significant challenge will be finding the revenues to finance expanded public coverage of institutional care. There is actually no political declaration on suggested mechanisms and one can wonder if this will remain a ‘ghost reform’ after more than a decade of promised long-term care financing reforms that were repeatedly delayed and ultimately not acted upon.”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.

---

World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

---

Page last updated Oct. 25, 2022 by Doug McVay, Editor.