France

132
Health systems in transition
France
5.4.1 Day care and other alternatives to full-time inpatient care
Alternatives to full-time inpatient care have been promoted since the late
1980s and encompass: part-time care provided in hospitals (either day or
night, including psychiatric care); ambulatory surgery (see above); ambulatory
treatments (séances) such as chemotherapy, dialysis, radiation therapy and
blood transfusions; HAD; and palliative care.
Of the 26 million hospital stays in 2011, more than half were for less than
a day, not including outpatient consultations (DREES, 2013c). Nearly 40%
of part-time hospitalizations are for psychiatric care, for which alternatives
to full-time inpatient care have been developed since the 1970s. Between
2000 and 2011, the number of part-time places increased by more than 50%,
from 16 000 to 36 000, and the density increased from seven to 10 places per
10 000 inhabitants.
Ambulatory treatments, such as chemotherapy and dialysis, are included
among the alternatives to full-time hospitalization, although they are not
counted as part-time hospitalizations. The vast majority of radiation therapy
treatments (96%) are performed in ambulatory care, mostly in private hospitals.
The public sector delivers the largest share (51%) of chemotherapy treatments,
although the 19 non-profit-making cancer centres (see section 4.1.1) provide
significant shares of both chemotherapy (13%) and radiation therapy (21%).
HAD units send medical or paramedical staff to the patient’s home on a daily
basis in order to provide continuous and coordinated care in situations where a
hospital stay otherwise would have been necessary. This form of intermediate
care is targeted at patients with serious, acute or chronic, progressive or unstable
disease requiring technical medical care of a certain degree of complexity and/
or intensity.
In 2014, HAD units provided a small share (1%) of full-time hospitalizations
and 0.5% of SHI expenditure. In 2014, there were 309 HAD units covering all
departments, accounting for 4 million days of treatment for 156 000 stays. The
government anticipates that this level of activity will double by 2018 (Cour des
comptes, 2013b). In 2013, the global cost was €859 million, and an average
HAD day costs SHI €196.8 (ATIH, 2014). Nearly one-fifth of HAD places
are located in the Paris region (DREES, 2013c). Administratively, HAD units
are generally either public hospital departments (42%) or private non-profitmaking
associations (39%). Each unit is led by a coordinating physician, who
is responsible for the overall coordination of medical care, while a coordinating
nurse organizes nurse’s rounds for individual treatments. Actual care is provided