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82 Health systems in transition <strong>France</strong> Care provided in private practice This target encompasses health professionals’ fees in private practice, including outpatient consultations in private hospitals, as well as prescription of drugs and medical devices, transport and per diem allowances for sickness and occupational accidents. SHI is responsible for ensuring compliance with the growth rates set by the government for these costs, which are included in the budget target agreed between the state and SHI. During their annual negotiations with health professionals, SHI defines expenditure targets for each profession and measures to enable them to be met. To ensure that the professionals’ national agreements on statutory tariffs are consistent with the ONDAM target, the agreements are not implemented for a six-month period and the newly negotiated tariffs only become effective if the target is not exceeded. Otherwise, the previously negotiated tariffs remain in force. The cost of medical goods prescribed in private practice is not directly regulated through the ONDAM. However, the annual Social Security Finance Act establishes a threshold rate of increase of the overall pharmaceutical companies’ turnover on reimbursable drugs: the K rate (taux K). Exceeding this rate results in financial penalties for pharmaceutical companies. However, there have been frequent criticisms of the discrepancy between the K rate and the ONDAM growth rate, the K rate being far below the ONDAM (0.4% for 2014 when the ONDAM was 2.4%). Health care provided by hospitals paid on a DRG basis This target encompasses spending by public and private hospitals paid on a DRG basis (T2A; see section 3.7.1) and other hospital spending. Since 2010, overspending the ONDAM hospital care target has been strictly prohibited. While the volume (case-mix) of hospital activity has far exceeded projections in recent years, the target has been underspent because of cancellation of reserve appropriations and lower than expected spending on other items within this target. Since 2013, a “prudential coefficient” has reduced the DRG tariffs for both public and private sector by 0.35%. This reserve may be partly or fully returned depending on the level of expenditure relative to the ONDAM target. Although the ARSs have both a strategic planning and an oversight role with respect to hospitals (see section 2.5.3), their impact on hospital budget allocations is more limited. Of the €42 billion allocated by the ARSs in 2010, they had decision-making power with respect to only €2.9 billion (Cour des comptes, 2012c).
Health systems in transition <strong>France</strong> 83 Health and social care for frail elderly and disabled financed by SHI Budgets corresponding to the targets for health and social care for the elderly and disabled are transferred to the CNSA (see section 3.6). The budget for the elderly is used to finance health care costs and a share of social care cost in nursing homes (établissements d’hébergement pour personnes âgées dépendantes) as well as the community nursing services (Services de Soins Infirmiers à Domicile; SSIAD). The budget for the disabled is used to finance nursing homes and SSIAD. Budgets are allocated to ARSs depending on service capacities in their geographical areas. The ARSs allocate budgets to services following the same principle (see section 2.5.1). Regional funding of specific programmes The ARSs are financed by a state appropriation (77%) and contributions from the SHI schemes (18%) and the CNSA (4%). The regional intervention funds were created under the 2012 Social Securing Financing Act and combine these appropriations and credits to facilitate the capacity of ARSs to undertake transversal actions in the following areas: 24-hour services; experimentation and adaptation of care delivery, including multidisciplinary teams; working conditions in health care institutions; modernization and pooling of facilities, including information systems; and health promotion, educational activities and prevention, with a particular focus on loss of autonomy. 3.3.4 Purchasing and purchaser–provider relations As already stated, SHI covers care provided by both public and private health care providers. Patients who consult these providers are reimbursed for a share of the cost of care (see section 3.3.1). The relationship of independent health professionals with SHI is defined at the national level in agreements called “conventions” signed between UNCAM (SHI) (see section 2.3.5) and representatives of the professions. Conventions exist for doctors, nurses, physiotherapists, dentists, midwives, pharmacists, speech therapists, chiropodists, orthoptists, heads of biological laboratories, providers of transport and certain medical devices suppliers (e.g. opticians and orthodontists). In 2012, the first interprofessional agreement (accord cadre interprofessionel) was signed. It was designed to facilitate experimentation in coordinated care, with a particular focus on post-hospitalization patient care, care for patients with chronic or multiple diseases, and home care for dependent individuals.
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Contents Contents Preface
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Preface Preface The Health Systems
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Acknowledgements Acknowledgements T
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List of tables, figures and boxes L
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Abstract Abstract This analysis of
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1. Introduction 1. Introduction The
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6. Principal health care reforms 6.
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7. Assessment of the health system
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8. Conclusions 8. Conclusions In Fr
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