Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

70 Special Solidarity Fund KCE Reports 133
Keypoints France
o The rationalization of healthcare: obligation to choose a regular GP,
personalized medical files and introduction of a new Carte Vitale (a
smart card containing the health beneficiary’s details) from 2007 to
2010.
o A complementary contribution by each beneficiary: contribution of
one non-reimbursable euro on each visit to a GP or specialist and flatrate
hospital contribution of €15.
o Combating fraud: more stringent checks on sick leave and Carte Vitale
bearing an ID photo.
• Act of 9 August 2004 on the public health policy, which introduces five
major five-year programmes and regional public health policy
management. The five programmes for 2004-2008 are:
o The cancer plan,
o The plan to combat violence, abuse, risk behaviour and addictive
behaviour,
o The plan to curb the impact of environmental factors on health,
o The plan to improve the quality of life of patients with chronic
illnesses,
o The plan to improve treatment and care for patients with rare
diseases.
• In France, the distinction is made between universal, public health insurance,
providing a standard benefits package for all residents (assurance maladie
obligatoire) through large occupation-based funds, and complementary
private health insurance.
• The principle of cost-sharing where patient are carrying a part of the cost
burden, or ticket modérateur, is extensively applied to public-financed
health services in France. However, there are safety nets for categories of
citizens that are exempt from co-insurance regulations and that are 100%
reimbursed: this applies for people with invalidity or with work injury,
people with specific chronic illnesses and low income patients.
• Health insurers have a public and statutory character with a membership
based on occupation. There is no competition and no system of risk
adjustment provided, even though there is inadvertent risk selection based
on occupation.
• Healthcare providers (extra muros and intra muros) charge their delivered
services in function of two elements: the classification (nomenclature) of
groups of services based on their nature, and the negotiated price for these
different service groups. The Nomenclature lists also all medicines that are
reimbursed by public health insurance to the patient.
• The French government elaborated an ambitious National Plan for Rare
Diseases 2005-2008. The Plan has the general aim to improve the equal
access to healthcare services for rare disease patients (from the diagnosis
phase to the reimbursement of costs).
• In France, the level of reimbursement of patients suffering from a rare
disease is strongly linked to the recognition of their disease as a chronic
disease. People that suffer from a chronic disease are exempted from costsharing
and thus fully reimbursed by the public health insurance fund. This is
only true for healthcare costs linked to the treatment of their chronic
disease and not for any other disease they might have.