France

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