France

168
Health systems in transition
France
that did not counterbalance the negative issues faced by doctors choosing to
live in areas that may be less attractive in terms of schooling for children, job
opportunities for spouses, and so on.
Alternatives to financial incentives: quality of life, new practice models
and task transfer
Innovation in regard to addressing geographical disparities has come from local
policy-makers, who face tremendous pressure to find solutions to this critical
situation. Local initiatives focused on improving the workplace quality of life
of doctors, rather than providing financial incentives, have flourished. Such
initiatives include providing practice structures so that doctors are not faced with
the high start up costs in establishing their practices; offering the opportunity
to work in group practices connected with other health professionals and so
eliminate the need to find replacement cover when they go on holiday, which
is often a problem for solo practitioners; paying doctors fixed salaries in lieu of
the traditional FFS arrangement; and covering their liability risk.
Other initiatives to address medical deserts focus on new methods of health
care organization that redistribute the role of different health care professionals
and improve their coordination or efficiency in order to decrease the need for
some categories of professionals and thus ameliorate accessibility problems.
Experimentation with task transfer between professionals was permitted
from 2004 and some such transfers have already taken place (e.g. between
ophthalmologists and vision therapists). In 2008, a recommendation regarding
the professional skill mix between doctors and other health care professionals
was issued by HAS and the National Observatory of Health Professions. The
proposed changes included a transfer of certain tasks from physicians to other
health care professionals, an improvement in the education and training of
nurses and a regulatory and financial framework for developing cooperation.
In 2009, the transfer of tasks and cooperation between categories of health
professionals was further encouraged, with protocols of cooperation being
provided under the supervision of the ARS. Health professionals may design
their own protocol or join an existing protocol that defines the nature of the
cooperation, the services involved and the place and scope of the professionals’
interventions. Task transfer has developed more slowly than expected for two
main reasons. First, there is opposition to task transfer because physicians are
paid on a FFS basis and so a reduction in the tasks for which they have a
monopoly reduces their revenue potential. Second, this approach also raises
a question of logistics: in the same zones in which an insufficient supply of
physicians is found, there are also fewer nurses and other health professionals
to perform the transferred tasks.