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132 Health systems in transition <strong>France</strong> 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
Health systems in transition <strong>France</strong> 133 by salaried staff from the HAD structure or by self-employed professionals. In 2014, HAD care was mainly provided in the areas of complex wound dressings (25.2% of days), palliative care (23.6%), heavy nursing care (11.3%), perinatal care (5.6%) (see section 5.10) and cancer treatment (6.0%), although it included all domains of hospital care, including rehabilitation and psychiatric care. In addition, HAD care has been extended beyond patient homes and since 2007 may be provided in long-term care facilities and other residential facilities, including those for disabled individuals since 2012. 5.5 Emergency care The scope of French health policy for emergency care encompasses the regulation of pre-hospital emergency care, the organization of hospital emergency departments, as well as the availability of appropriate hospital beds for patients admitted by emergency departments. Emergency care was reorganized following the 2003 heat-wave under the Emergency Care Plan 2003–2008 (Plan urgences 2003–2008). Pre-hospital emergency care is handled by medical emergency call centres (services d’aide médicale urgente) and the continuity of care system (permanence des soins). The medical emergency call centres are freely accessible nationwide from any phone by dialling 15. The centres share information with the emergency call centres of the police (17) and fire brigade (18), so that medical emergencies are appropriately addressed. Likewise, either the medical or the fire brigade call centres respond to the European emergency number 112. Emergency calls that reach the medical call centre are treated by specialized receptionists who are supervised and supported by physicians. The actions taken depend on the level of emergency. If on-site first aid is needed, the medical emergency call centres can send a mobile intensive care unit (services mobiles d’urgence et de reanimation), a first-aid team from the fire brigade or an on-call primary care physician. Otherwise, the patient would be advised to go to the nearest emergency hospital by ambulance if necessary. Finally, the patient may be advised to call back after a few hours in order to confirm the symptoms or to schedule a GP consultation.
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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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Abstract Abstract This analysis of
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1. Introduction 1. Introduction The
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3. Financing 3. Financing Health ca
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