France

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Health systems in transition
France
by SHI, in part by direct funding of the investments (€1.5 billion) and in part
by underwriting 20-year loans to the hospitals (€4.5 billion). The Hospital
Plan 2007 also provided for public–private partnerships (partenariat public–
privé), and each of the regional hospital agencies (Agences régionale de
l’hospitalisation, predecessors to the ARSs) was to propose at least one public–
private partnership investment project. The French Accounts Commission
(Cour des comptes) criticized the realization of these partnerships as being
insufficiently planned and executed (Cour des comptes, 2014a). Since 2012,
national oversight of investments undertaken by the ARSs and valued at over
€50 million is provided by the Interministerial Committee for Performance
and Modernization of the Health Care Supply (Comité Interministériel de
Performance et de la Modernisation de l’Offre de Soins).
The second investment plan, Hospital Plan 2012, was introduced in 2007
in order to extend the previous investment cycle. This new plan involved an
initial endowment of €7 billion, again financed by SHI through direct funding
(€5 billion) and through access to public lending at preferential interest
rates (€2 billion). This plan has three major priorities: hospital information
technology systems, restructuring of hospital facilities at the regional level (e.g.
collaborations and mergers between hospitals) and improvement of compliance
with safety standards (e.g. seismic compliance and asbestos removal).
In 2013, the strategy to support investment in health was reinforced with the
goals of ensuring that investments were aligned with patient pathways, that they
conformed to the strictest standards, that they integrated digital programmes
and that they ensure financial sustainability. Regional schemes for investment
in health (schémas régionaux de l’investissement en santé) were put into place
in 2013, with the objective of ensuring coherence of investments at the regional
level. Part of the focus of the regional schemes involves examining investments
undertaken within the previous 10 years and identifying existing capacity
available to meet the needs identified by the ARSs. This effort will be aided
by the data compiled by the OPHELIE tool, which will enable consideration of
future investment projects in light of existing property assets.
In December 2013, the French Government signed an accord with the
European Investment Bank, which will finance public and private hospital
construction and renovation projects under the Hospital of the Future
Programme, amounting to €1.5 billion over three years.