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186 Health systems in transition France 7.4.2 Health service outcomes and quality of care There have been many recent initiatives to improve health care quality and its measurement in France. Over the past decade, a French project team has collaborated to develop and validate a series of patient safety indicators. Since 2008, the HAS has undertaken national campaigns to collect data on quality and security indicators for hospitals, which are now required not only to collect the data but also publish it (see Scope Santé, section 2.9.1). The National Programme for Patient Security 2013–2014 (Programme national pour la sécurité des patients) is a key element in the 2012 National Strategy for Health. Preventive care The development of prevention policies within a system built upon a curative focus has been fairly recent, starting in 2002 and increasing in emphasis after 2010 when a framework for actions to support prevention, health promotion and therapeutic education was designed. It is currently the major aim of the National Strategy for Health and the planned 2015 Health Reform Law (see section 6.2). A wide range of actors is involved in prevention policy at the national level, which has complicated coordination and led to interministerial governance of this issue. Immunization services are well organized in France (see section 5.1.3), and child vaccination rates are high: at age 2, 98% of children were vaccinated for diphtheria, tetanus, polio and pertussis (DTPCoq in French) in 2010 and 90% for measles in 2011 (Fontenau, Guthmann & Lévy-Bruhl, 2013). Influenza vaccinations for individuals age 65 and older are covered 100% by SHI. During the 2010–2011 influenza season, the vaccination rate for persons of this age group suffering from chronic illnesses (most frequently cardiac disease and diabetes) was 71%, while it fell to 57.8% among those who were not chronically ill (Guthmann, Fonteneau & Lévy-Bruhl, 2012). Care for patients with chronic conditions The French health care system is oriented to curative care as opposed to managing long-term chronic diseases, which are complex and require the involvement and coordination of various professionals belonging to the hospital, ambulatory and health and social care sectors. Given that the number of people with chronic conditions has increased alongside longer life expectancy and medical progress, increasing attention has been paid to improving coordination of care and developing care models that are better equipped to meet the needs and improve the quality of life of the chronically ill population. Some of these initiatives come from the SHI, which has developed disease management
Health systems in transition France 187 programmes: first, one focusing on patients with diabetes and, since late 2014, one focusing on patients with asthma. Moreover, indicators of good follow-up of chronic diseases have been introduced in ROSP (see section 3.7.2). The HAS has also developed guidance for pathways for patients with the following chronic conditions: chronic obstructive pulmonary disease, Parkinson’s disease, chronic kidney disease, congestive heart failure, bronchopulmonary cancer and malignant pleural mesothelioma, Hodgkin’s lymphoma (adult), type 2 diabetes (adult) and atrial fibrillation. These guides aim to help physicians better deal with acute episodes and to retard the progression of the disease to the extent possible by improving care practice and coordination as well as by fostering patient involvement and participation in care, particularly through therapeutic patient education. Moreover, tools for patients and health professionals are provided. However, one of the limitations of such programmes is that while doctors have a high level of awareness of practice guidelines published by HAS, the recommendations may not be assimilated because they are too long and sometimes confusing. For example, a 2013 report of the National Academy of Medicine (Académie nationale de médecine) identified a number of areas of overprovision of care, including excessive biological testing and high-technology imaging and overprescription of drugs (Mornex, 2013). For cancer screening, a large number of mammographies are undertaken over age 75, despite the recommended age cut-off, resulting in overdiagnosis of small lesions of limited medical interest that do not change the life expectancy of the patient and may expose her to needless anxiety, additional testing and even surgery. Moreover, the management of acute episodes and disease-related complications is a key element in ensuring high quality care for patients with chronic conditions and avoiding unnecessary hospitalizations. For avoidable hospital admissions for adults with asthma and chronic obstructive pulmonary disease, France has much lower rates than the OECD26 averages (OECD, 2013). Nonetheless, regional variations in the rate of hospitalizations for exacerbations of chronic obstructive pulmonary disease, ranging from 0.1 to 2.0 per 1000 in 2010, have led the Ministry in charge of Health and the largest SHI fund to request a study by the HAS regarding the appropriateness of hospitalizations during such acute episodes (HAS, 2012). Better data are needed for certain conditions. For example, avoidable hospital admission rates are not available for diabetes because it is not necessarily included as secondary diagnosis in the PMSI database, which also does not include the patient’s ALD status.
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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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