France

Health systems in transition France 95
In private profit-making hospitals, doctors’ procedures and services are not
included in GHS tariffs and are paid separately, while they are included in the
GHS tariffs for the public hospitals. Specific GHS tariffs are calculated for the
private sector, together with an individual “transition coefficient” that aims to
avoid large changes in hospital budgets from year to year and takes into account
each hospital’s own historical costs/prices. Regional weights, similar to those
of the public sector, are also used in the private sector, as well as a technical
coefficient that applies to hospitals offering high-technology services.
Finally, special financing rules apply to hospitals in low-density,
geographically remote areas that would otherwise be subject to consolidation
because of low volume of use.
Payment for mental health care
Psychiatric areas provide integrated inpatient and outpatient public mental
health care, generally coordinated by a hospital specialized in mental health
and paid on an annual prospective global budget basis, as are private psychiatric
hospitals (see section 5.11). An information system, “summary of medical
information for psychiatry” (recueil d’informations médicalisées en psychiatrie),
has been implemented, but the payment mechanism (valorisation de l’activité
en psychiatrie) is still being developed.
Outpatient care provided by self-employed GPs or psychiatrists is paid for on
a FFS basis. Consultations for psychotherapy provided by other self-employed
professionals are also paid on a FFS basis, but tariffs are freely set by providers
because there is no coverage by SHI.
Payment for pharmaceutical care
Outpatient pharmaceutical care is paid according to the official tariffs defined by
CEPS (see section 2.8.4). Prices and payments for drugs are made on a package
basis, and distribution of partial packages is prohibited even if it exceeds the
number of units prescribed. However, under the 2014 Social Security Finance
Act, a three-year voluntary project will test delivery of antibiotics on a unitary
basis in retail pharmacies.
Drugs with marketing authorization that are not contained in the list of
reimbursable drugs or for special drugs for inpatient care (see section 2.8.4)
may be sold over the counter, with patients paying the full price, which is not
regulated. Previously, VHI did not cover drugs not covered by SHI.
Inpatient pharmaceutical care is included in the GHS tariffs paid by SHI to
the hospitals, with the exception of innovative expensive drugs, which are paid
for on top of the GHS tariffs if listed on the special agreed products list.