France

Health systems in transition France 107
Inpatient classification system
Data from the PMSI (see section 2.7.1), which was first developed in the 1980s
and became exhaustive with respect to acute care in 1996, formed the backbone
of the T2A (see section 3.7.2), which has been in use since 2004.
Electronic billing
An electronic billing system has been gradually developed and implemented
in the ambulatory care sector since the mid-1990s. An individual health
insurance electronic card (Sesam-Vitale carte) is provided to all individuals
enrolled in SHI. On the provider side, the billing system relies on an electronic
identification card for health care workers (Carte de Professionnel de Santé).
By 2012, 98% of doctors had such a card (Asip Santé, 2012).
DMPs
DMPs were instituted by the 2004 Health Insurance Act (Loi No. 2004–810 du
13 août 2004 relative à l’assurance maladie), with the aim of grouping medical
information gathered in ambulatory and hospital settings. After a long and
costly phase of development and testing, the DMP was finally rolled out on a
national basis in 2011. The decision to create a DMP is made by the patient on
a voluntary basis, and participation has been very low: as of November 2013,
only 5291 ambulatory health professionals and 378 health care facilities had
incorporated the use of DMPs and 397 714 had been created.
Since January 2009, a system of patient pharmaceutical files (dossiers
pharmaceutiques) has been progressively rolled out nationally. The file is
created and accessed with the patient’s consent and allows pharmacists to
check patients’ prescriptions within the previous four months, with the goal of
preventing unnecessary prescriptions and contraindicated drug combinations.
By December 2012, 98.4% of all pharmacies in France had installed the
necessary equipment.
Electronic appointment booking systems
Certain hospitals, both public and private, offer the option of making
appointments for consultations online. However, such systems are far from
being generalized in France.
Incentives to expand use of information technologies
Because of the low professional interest in adopting electronic records, incentives
have been put into place. The P4P provisions under ROSP (see section 3.7.2)
include incentives for physicians to increase the use of information technologies
in ambulatory care, including the electronic transmission of reimbursement
claims by SHI and software for following patients and managing prescriptions.