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100 Health systems in transition France for the geographical distribution of medical professionals, as self-employed professionals are free to choose where they practise. In order to solve the resulting great disparities in the distribution of medical professionals, there has been increasing transfer of tasks from medical to other professionals such as nurses and the development of incentives for attracting health professionals to underserved areas. 4.1 Physical resources 4.1.1 Capital stock and investments Current capital stock At the end of 2011, there were 2694 hospitals in France. Non-profit-making institutions accounted for 61% (35% public and 26% private sector) and 39% were private hospitals operated for profit (DREES, 2013c). The 947 public hospitals account for nearly two-thirds of inpatient beds (258 156 out of 414 395). There are three main types of public hospitals: • 33 regional hospitals (centres hospitaliers régionaux), with the highest level of specialization and the technical capacity to treat more complex cases; most are linked to universities and operate as teaching hospitals; • 802 general hospitals (centres hospitaliers), which account for the majority of short-term inpatient stays; among the general hospitals are ex-local hospitals, small community-level structures that fulfil a health and social care function, offering acute medical care, follow-up care and rehabilitation, and long-term care; and • 88 hospitals specializing in psychiatric care (centres hospitaliers spécialisés). There are also 24 other public establishments, primarily imaging and radiotherapy centres. Private hospitals fall into two categories: non-profit-making or profitmaking. Non-profit-making hospitals are owned by foundations, religious organizations or mutual insurance associations. In 2011, they accounted for 26% of hospitals (700) and 14% of inpatient beds (11 778). Two-thirds of private non-profit-making hospitals perform public service duties such as emergency care, teaching and social programmes for deprived populations; they are known
Health systems in transition France 101 as “participants in public hospital service” (participant au service public hospitalier). Nineteen of them specialize in cancer treatment, with a broad remit that includes prevention, screening, treatment, teaching and research. The private profit-making sector plays an important role in the French health care system. The share of hospitals that are operated for profit is higher than in most developed countries: private profit-making hospitals accounted for 39% of all hospitals (1047) and 24% of all inpatient beds (98 522) in 2011. They also accounted for 22% of part-time hospitalization places and tend to specialize in areas with higher profit opportunities (see section 5.4). The market for hospital care is becoming increasingly concentrated. The number of hospitals has been declining since 1990, mainly because of hospital closures and mergers within the private sector. Nonetheless, new modes of cooperation may result in an increase in the number of hospitals over the next few years. The overall area of the property assets of public hospitals is estimated at 60 million square metres, a scale comparable to the rest of the state’s property holdings. However, to date, record keeping has not been standardized among hospitals, and consequently the Ministry in charge of Health has lacked reliable data in this regard (Cour des comptes, 2013a). In 2014, a new tool called OPHELIE was launched to remedy this problem by standardizing the inventory control and facilitating management of hospital property assets. Focusing initially on hospitals with investment projects, those undergoing audits as well as hospitals volunteering to participate, it will be rolled out to all public hospitals by 2017. Investment funding Depending on the specific sector and public health priorities, capital investments in the health care sector are either covered by reimbursements for service delivery or funded by specific national or regional programmes. Between 1983 and 2003, the public and private non-profit-making sectors suffered from a lack of investment because of the financial constraints imposed by the global budget payment system in place at that time. Since then, two nationwide investment programmes have been launched to support improvements to meet current quality and safety standards: Hospital Plan 2007 (Plan Hôpital 2007) and Hospital Plan 2012 (Plan Hôpital 2012). Hospital Plan 2007 was launched in 2003 as part of an ambitious reform of the hospital sector; €6 billion was invested over five years for select projects proposed by public and private hospitals. The plan was to be entirely funded
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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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