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34 Health systems in transition <strong>France</strong> Several health and social services that are not under the remit of the ARSs come under the jurisdiction of the General Council (see section 1.3). These include: • health and social care institutions and services for elderly and disabled people (nonmedical facilities come under the authority of the general councils, who supervise and finance them through social assistance budgets, while facilities combining social and medical services come under the joint supervision of the state and the general councils); • social welfare and work programmes supporting individuals with low incomes, elderly and disabled people in institutions and financing of home assistance; • protection of children, particularly through the management of PMI centres, which offer consultations and free health care; • prevention of certain diseases, such as tuberculosis, sexually transmitted diseases and cancer; and • public health and hygiene (environmental health, sanitation, etc.), in conjunction with municipalities. 2.5 Planning 2.5.1 Capacity / capital planning Health services are provided by office-based physicians and hospitals. Officebased physicians are self-employed. Ownership of hospitals is divided among government (public hospitals); non-profit-making organizations that are linked to the public sector and tend to be owned by foundations, religious organizations or mutual-insurance associations; and private profit-making hospitals, ownership of which is increasingly concentrated in large international groups. Responsibility for planning health system resources and capacity is shared by the Ministry in charge of Health and the 26 ARSs. The goal of this partial devolution of the planning function is to enable regional authorities to meet the health needs of the population more appropriately. Hospitals Other corporate actors, such as the hospital federations (see section 2.3.6) and public representatives, also participate in the planning process and may play an important role during consultations. The regulatory framework for hospitals applies equally to public, private non-profit-making and private profit-making providers.
Health systems in transition <strong>France</strong> 35 Planning largely takes place at the regional level, involving the CRSA and the ARSs. The Ministry in charge of Health has a stewardship role, establishing a catalogue of health services that the regions must incorporate in their plans based on a national assessment of needs and (sometimes politically driven) priorities. The strategy is mainly implemented through a regional health organization plan (Schema Régional d’Organisation de soins; SROS) developed by the ARSs in consultation with the stakeholders (including the Ministry in charge of Health) who participate in the CRSA. Developed every five years, the SROS aims to tailor health care delivery to local needs by setting strategic goals for health care delivery and defining priorities based on the objectives of the PSRSs. Strategic planning requires the ARS to assess population health needs based on regional data regarding health care utilization, mortality and morbidity. Data are analysed by region and compared across regions to identify demand and over- or undercapacity. The SROS also forms the legal basis for multiyear contracts for targets and resources contracts (contract pluriannuels d’objectifs et de moyens) between hospitals and the ARSs in terms of the responsibilities of each hospital and the volume of services to be provided. These contracts are typically negotiated for a period of five years and require hospitals to obtain authorization from the ARS for the services they provide (including expensive health technologies). They also require annual evaluation of existing capacity and service volumes. Hospitals may be financially penalized (up to 5% of total revenue) for failure to adhere to target contracts and the ARSs may suspend the authorization for the service. However, to date no hospital has been penalized. A new model contract was negotiated by the Ministry in charge of Health and the hospital federations for the SROSs for 2013–2018. Health and social care services for the frail elderly and disabled Since the creation of the ARSs, planning is done through an organizational pyramid. 1. At the top of the pyramid, a regional scheme for organization of the health and social care sector (Schéma Régional de l’Organisation Sociale et Médico-Sociale) is established by the director of the ARS, on the advice of a dedicated ARS commission, the coordination committee dedicated to the health and social care sector (Commission de coordination dédiée au secteur médico-social), composed of representatives of the state, of the general councils and of the social security schemes involved in financing the sector, and of the heads of the general councils. This regional scheme should meet the objective of the PRS.
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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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