France

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Health systems in transition
France
The significant burden of chronic diseases exacerbated by an ageing
population and the increasing level of obesity have underscored the need for
ongoing monitoring and treatment as well as preventive strategies to reduce the
incidence and burden of chronic diseases such as diabetes. However, the focus
of the health system has been on acute care rather than long-term chronic care
and prevention.
In light of these issues, the health care system in France has undergone a
series of reforms since 2010 to increase equity in access to care for socially
disadvantaged individuals, those living in underserved geographic areas and
the most vulnerable populations.
Recent reforms have focused on addressing access barriers to health care
and improving chronic and long-term care to better meet population needs.
The level of equity in access has improved for individuals with the lowest
revenues thanks to expanded eligibility for CMU-C and financial assistance
to purchase ACS. Third-party payment for beneficiaries of these programmes
has further reduced the financial barriers to accessing care, although extension
of third-party payment to all SHI beneficiaries has drawn strong opposition
by physicians. In addition, the quality of VHI contracts has been an ongoing
concern, given the importance of VHI in financing health care. A new mandate
will require all employers to offer and partially finance group VHI contracts
for employees from 2016.
The so-called medical deserts have been a priority on the political agenda
for over two decades. However, because French physicians have freedom of
settlement, it is challenging to address this issue. Coercive measures were
considered but abandoned because of the significant political power of doctors,
and financial incentives have been generally unsuccessful. Government reform
efforts have shifted to multidisciplinary practice models, task transfer and the
use of information technologies such as tele-health as means of compensating
for lower physician density, particularly in rural areas. Moreover, promising
initiatives focusing on improving the workplace quality of life of doctors have
flourished at the local level.
Measures to improve chronic and preventive care have been implemented,
and early results show some practice improvements. Physicians have embraced
P4P, despite initial resistance from their unions, and better monitoring of
patients with chronic diseases such as diabetes has been documented. However,
objectives related to prevention, including vaccination and cancer screening,
have shown mixed results. Financial incentives to improve care coordination by
GPs are also being tested as part of regional pilot projects designed to improve
care for frail elderly individuals.