JANUARY

FRANCE
socially marginalized people. It produces practice guidelines for the health and social care sector and evaluates
organizations and services.
The National Health Authority (HAS) is the main health technology assessment body, with in-house expertise as
well as the authority to commission assessments from external groups. The HAS remit is diverse, ranging from
the assessment of drugs, medical devices, and procedures to publication of guidelines, accreditation of health
care organizations, and certification of doctors.
Competition is limited to VHI, whose providers are supervised by the Mutual Insurance Funds Control Authority.
What are the major strategies to ensure quality of care?
National plans are developed for a number of chronic conditions (e.g., cancer, Alzheimer’s), rare diseases,
prevention, and healthy aging, in addition to the 104 targets set by the 2004 Public Health Act. These plans
establish governance (e.g., the cancer plan to coordinate research and treatment in cancer and establish
guidelines for medical practice and activity thresholds), develop tools, and coordinate existing organizations. All
plans emphasize the importance of supporting caregivers and ensuring patients’ quality of life, in addition to
enforcing compliance with guidelines and promoting evidence-based practice.
The National Health Authority publishes an evidence-based basic benefit package for 32 chronic conditions.
Further guidance on recommended care pathways covers chronic obstructive pulmonary disease, heart failure,
Parkinson’s, and end-stage renal disease (Assurance Maladie, 2015).
SHI and the Ministry of Health fund “provider networks” in which participating professionals share guidelines
and protocols, agree on best practice, and have access to a common patient record. Regional authorities fund
telemedicine pilot programs to improve care coordination and access to care for specific conditions (e.g.,
stroke) or populations (e.g., newborns, the elderly, prisoners). The PAERPA (Personnes Agées en Risque de
Perte d’Autonomie) program, established in 2014 in nine pilot regions, is a nationwide endeavor to improve the
quality of life and coordination of interventions for the frail elderly.
For self-employed physicians, certification and revalidation are organized by an independent body approved by
the National Health Authority. For hospital physicians, both can be performed as part of the hospital
accreditation process.
To ensure the lifelong quality of their practice, doctors, midwives, nurses, and other professionals must undergo
continuous learning activities, which are audited every fourth or fifth year. Optional accreditation exists for a
number of high-risk medical specialties (e.g., obstetrics and gynecology, surgery, cardiology). Accredited
physicians can claim a deduction on their professional insurance premiums.
Hospitals must be accredited every four years; criteria and accreditation reports are publicly available on the
National Health Authority website (www.has-sante.fr). CompaqH, a national program of performance indicators,
also reports results on selected indicators. Quality assurance and risk management in hospitals are monitored
nationally by the Ministry of Health, which publishes online technical information, data on hospital activity, and
data on control of hospital-acquired infections. Currently, financial rewards or penalties are not linked to public
reporting, although they remain a contested issue. Information on individual physicians is not available.
What is being done to reduce disparities?
There is a 6.3-year gap in life expectancy between males in the highest and males in the lowest social
categories (DREES, 2015) and poorer self-reported health among those with state-sponsored or without any
complementary insurance. The reduction of health inequities is a major target of the 2014 National Health
Strategy, and the 2004 Public Health Act set targets for reducing inequities in access to care related to
geographic availability of services (so far, only nurses have agreed to limit new practices in overserved areas),
financial barriers (out-of-pocket payments will be limited by state-sponsored complementary insurance), and
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