France

Health systems in transition France 193
The foremost target for efficiency efforts has been the hospital sector. The
French health care system has long had a hospital-centric, curative orientation.
The number of full-time beds in France is among the highest in Europe by
population (see Fig. 4.1a), while the occupation rate is only 67%. Therefore, the
challenge is to reduce hospital capacity while maintaining a network of hospitals
that responds to regional needs for emergency services and overall access to
care. However, the activity-based financing model (T2A; see section 3.7.2) may
undermine efforts to improve efficiency because tariffs are established based
on demand that already has been identified as suboptimal.
While average length of stay has steadily fallen since the mid-1990s (see
Fig. 4.1b), the rate of ambulatory hospitalizations remains far below that of
neighbouring countries. The estimated savings from a shift to ambulatory
surgery could amount to €5 billion or 7% of the ONDAM target for hospital
expenditure. Other efficiency measures include combining certain resources
across hospitals and redeploying personnel based on actual rather than
maximum capacity (IGAS, 2012b).
Reducing inefficiency in the hospital sector also involves better organization
of primary care. For example, fewer patients should be sent directly to emergency
care as part of the broader effort to avoid unnecessary hospitalizations, but
this requires ready access to GPs and after-hours care. Multidisciplinary care
models are seen as one answer to meeting these needs, although expansion has
been hampered by lack of agreement regarding remuneration and task transfer.
Moreover, in order to facilitate better coordination across sectors to improve
both efficiency and quality of care, information technology systems must be
interoperable and used on a widespread basis. However, this objective remains
far from being met, particularly with respect to information technology systems
in doctors’ private offices (see section 4.1.4).
Increasing the market share of generics among prescribed drugs is a key
efficiency goal. However, the list of substitutable drugs in France is relatively
limited compared with other European countries (see section 6.1.2). In addition,
consumer reluctance to embrace generics, compounded by doctors who indicate
on the prescription that the drug may not be substituted, has further limited
growth. Incentives aimed at both doctors and pharmacists have been used to
spur growth of the generic market. For example, the prescription of generic
statins has generally increased as new generic forms have entered the market.
However, between 2006 and 2011, a downward trend emerged. Since 2012,
prescription of generic statins has been among the efficiency indicators for the
ROSP, and resulted in a 6.9 percentage point increase by March 2013.