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56 Health systems in transition France (Agendas d’accessibilité programmée), provides extended deadlines of one to six years to entities that agree to make all of the required changes within a defined time frame. 2.9.4 Complaint procedures The 2002 Patients’ Rights and Quality of Care Act enumerated the general rules for patient complaint and compensation procedures, which differ depending on the setting in which care is delivered. It also established the possibility for patients to obtain compensation without demonstrating that there was an error either by a health professional or by an institution and simplified the procedure for patients pursuing claims in court (for more details see section 2.5.6 in Chevreul et al., 2010). In public hospitals, the first step of a patient’s complaint (before a formal case is brought against the hospital) is addressed through a conciliatory procedure involving the hospital mediator (usually a senior physician) and the patient or the patient’s family. Patients with complaints against self-employed doctors (office-based or working in private profit-making hospitals) may bring a case against doctors in the courts of justice and may bring a case to the physician’s professional association. The physicians’ associations are qualified to take disciplinary sanctions against their members. 2.9.5 Public participation Patients and their representatives may participate in the CRSA in defining public health priorities at the regional level, including development of the PSRS (see section 2.3.7). Nonetheless, patient participation remains insufficient, although it is stronger at the hospital level. Therefore, measures to improve patients’ participation are part of the planned 2015 Health Reform Law (see section 6.2) by putting representatives of patients on the board of each health agency and enlarging hospital patients’ commissions, which will be consulted on the hospital quality and safety policy and informed of adverse events. 2.9.6 Patients and cross-border health care Unanticipated emergency care for French SHI beneficiaries travelling outside of France, including outside the EEA, may be reimbursed at the usual SHI tariffs upon presentation of the bills and justification of the urgency of the medical
Health systems in transition France 57 need. Within the EEA and Switzerland, medically necessary care arising in the context of short stays (holidays, professional travel, language study, etc.) is facilitated by European health insurance card (carte européenne d’assurance maladie), which ensures that care is provided under the same conditions as for beneficiaries in that country. For planned ambulatory care in a foreign country covered by regulation or agreement, the patient is not required to seek pre-authorization from the SHI fund and normally would pay for the services and then submit the bills for reimbursement based on the usual SHI tariffs. For scheduled hospitalizations and treatments involving major equipment (MRI, PET, etc.), the patient must seek authorization from the SHI fund, explaining the nature and reasons for seeking treatment outside of France. Hospitalizations are usually authorized unless it involves a treatment not covered by SHI. In 2012, France reimbursed €583 million for cross-border health care, which constitutes a 43% increase over 2011 (Centre for European and International Liaisons for Social Security, 2012). Care provided for French SHI beneficiaries in Belgium, Spain and Portugal accounted for two-thirds of the cross-border reimbursements.
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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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