France

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Health systems in transition
France
While this measure should result in greater equality in complementary coverage
among employees, it has a number of shortcomings. Changes to the individual
market for VHI, including a potentially less healthy population, may result in
premium increases for those contracts.
In addition, the rules for “responsible contracts” (see section 3.5.3) are
also being used as a tool to ensure greater equity in the extent of coverage by
contract. The current reform, effective from April 2015, aims to reduce OOP
payments by expanding the minimum coverage requirements to include 100%
of the co-insurance amounts for official tariffs for all forms of care, except for
thermal treatments, homeopathic drugs and drugs reimbursed at 15% or 30%. In
addition, responsible contracts will be required to fully cover the daily hospital
catering fee (see section 3.3.1), regardless of the length of hospitalization, and
must provide at least minimum coverage of optical care. Moreover, this reform
also involves group contracts. Employer-provided group VHI contracts will be
required to cover dental prosthetics up to 125% of the official tariffs as well as
a higher minimum level of optical care.
Medically based cost-containment
The concept of medically based cost-containment focuses on prescribers’
behaviour; it aims to decrease medical practice variations by improving
physicians’ knowledge and rewarding good practice although financial
incentives (see section 7.1.2 in Chevreul et al., 2010), which recently has
included P4P mechanisms.
In recent years, lifelong learning through continuing medical education
( formation médicale continue) has been subject to major changes (see
Chevreul et al., 2010). From 2010, a new DPC (model 22) for health professions
in the ambulatory sector was developed with a centralized managing body
(Organisme gestionnaire du développement professionnel continu). It was
designed to ensure quality and independence from the pharmaceutical industry
and to evaluate and facilitate registration for training programmes. To date,
implementation of the DPC has been problematic, with the continuing education
obligation undefined in terms of content, number of hours and sanctions and the
financing mechanism insufficient (IGAS, 2014a). However, a growing number
of doctors are fulfilling this obligation.
On the financial mechanism side, a voluntary P4P scheme was introduced in
2009, consisting initially of voluntary contracts between SHI and GPs to improve
individual practice (Contrats d’amélioration des pratiques individuelles) (see
section 3.6.2 in Chevreul et al., 2010); GPs agreed to meet specific goals
including chronic disease management, preventive health care and targets for