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138 Health systems in transition <strong>France</strong> • exception drugs (médicaments d’exception) are not covered by SHI unless they are prescribed for the indications set out in the therapeutic information sheet (fiche d’information thérapeutique), and if the indication is not included, the prescribing doctor must inform the patient that the drug will not be covered; and • narcotics and related drugs must be prescribed using a secure prescription form and must be filled within three days of the date of prescription. 5.6.4 Reforms Reforms have primarily focused on reducing system costs for drugs, including de-listing drugs assessed by the Transparency Commission as having low SMR (see section 6.1.2). Patients and pharmacists have been given strong incentives to accept generic drug substitution. Since 1999, generic substitution has been promoted: pharmacists receive financial incentives and if patients refuse to accept the generic drug, they must pay the full price and claim reimbursement afterwards. The 2014 Social Security Finance Law included a provision promoting biosimilar drugs, but with certain restrictions, including the express authorization of the prescribing doctor. From April 2014, experimentation started in 78 pharmacies on unit dispensing, which authorizes pharmacists to sell a given list of antibiotics and drugs by unit and not by box, with the aim of diminishing waste and, therefore, cost. Currently, almost all medications are sold in fixed quantities in boxes that are pre-packaged by the manufacturers. Improper use of antibiotics has been a particular focus of policies as well as education campaigns targeted at patients. The P4P provisions of ROSP include targets related to prescription of antibiotics (see section 3.7.2). 5.7 Rehabilitation/intermediate care Depending on a patient’s condition after acute treatment, rehabilitation care may be delivered in an inpatient or an outpatient setting. Following a hospital stay for acute care, a patient would typically be transferred to an inpatient follow-up and SSR unit as soon as daily monitoring by acute care specialists is no longer necessary. The SSR unit might be a general rehabilitation unit or a specialized unit, depending on patient needs. The SSR
Health systems in transition <strong>France</strong> 139 unit then would discharge the patient home when she/he is able to perform daily life activities. Subsequent rehabilitation care would be performed by a physiotherapist working in an ambulatory setting and coordinated by the GP. More than half of SSR stays are for rehabilitation, although the type of care offered in terms of pathologies, population and setting varies by sector. Public units account for 40% of SSR capacity, most of which are integrated within general hospitals. Public SSR units are dominant with respect to mental illnesses and nervous system disorders. The private profit-making sector has the smallest share of total SSR capacity (just over 25%), with 40% of care devoted to orthopaedic, cardiology and post-trauma rehabilitation, often in dedicated clinics. One-third of SSR capacity is found in private non-profit-making units, which provide follow-up care for a broader spectrum of pathologies, with a particular focus on children and adolescents. The burden and complexity of SSR stays has increased in recent years because of the ageing of the population and also the shorter length of stays in acute care hospitals, which diminished by 17% between 2001 and 2009. In the same period, there was only a 3% decrease in the lengths of stay in SSR units because of the increase in the number of very long stays (more than three months), mostly the result of difficulties in discharging patients to other, more appropriate care settings because of a lack of capacity. SSR units are also challenged by unsuitable admissions, estimated at 10–20%, including patients admitted from acute care before being sufficiently stabilized, as well as those who may not require inpatient rehabilitation services but are awaiting admission into long-term care facilities or the availability of SSIAD places (Cour des comptes, 2012b). The organization of SSR was reformed in 2008 and since that time capacity has expanded rapidly, although geographic disparities remain. Moreover, regions with SSR capacity below the national average also have low density of physiotherapists in the ambulatory sector, thereby compounding the lack of access to rehabilitation care (DREES, 2011b). The ARSs are responsible for planning and optimizing the organization of rehabilitation services. The most recent SROSs have focused on improving coordination between the health sector and the medicosocial sector, as well as developing alternatives to inpatient SSR, including rehabilitation services in the context of day hospitalization, HAD and mobile rehabilitation teams.
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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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List of tables, figures and boxes L
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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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