THE FRENCH HEALTH SYSTEM. Yann Bubien. University Hospital General Director, Angers

Transcription

1 THE FRENCH HEALTH SYSTEM Yann Bubien University Hospital General Director, Angers 1

2 INTRODUCTION International studies have confirmed that France has one of the best-performing healthcare systems in the world This system comes at a cost : - France devotes around 11% of net gross domestic product (GDP) to healthcare expenditure ( 215 billion) - Average healthcare expenditure per inhabitant is US$3,601 in France 2 major recent laws : - Liberties and Responsibilities of Universities (Law LRU) voted in The Hospital, Patients, Healthcare and Regions (Law HPST) voted in

3 THE FRENCH HEALTH ORGANISATION 3

4 ARS 4

5 REGIONAL HEALTH AGENCIES (ARS) 26 Regional Health Agencies (ARS) 3 aims : - ensuring better co-ordination of treatments - making sure that resources are managed in a more consistent manner - guaranteeing a more balanced access for the population as a whole. 5

6 HOSPITAL PLANNING The Regional Public Health Organization Program (SROS) is the patient care planning tool The program sets patient care priorities at the regional level over a five-year period, with the aim of rationalizing hospital treatment provision in the area and improving the quality of treatment. The program oversees the gradual organization of specialist platforms and promotes alternative solutions to hospitalization (keeping patients at home and local activities). 6

7 CERTIFICATION The National Health Authority (HAS) has awarded renewable certificates to hospitals and clinics 7

8 FUNDING The level of public sector hospital expenditure is divided into regional allocations, which are distributed in turn by the Regional Health Agencies (ARS). The State provides support for investment in hospitals through multiyear funding plans that amount to several billion euros. A new funding method: rating per activity, T2A. 8

9 T2A Rate-setting per activity stems from a mixed funding system that differentiates between treatment and public interest assignments (research, teaching, etc.). Rate-setting per activity only concerns medical, surgical and obstetric procedures 9

10 THE FRENCH HOSPITAL SECTOR 10

11 THE FRENCH HOSPITAL SECTOR 2,880 treatment institutions 448,500 full-time hospital beds around 53,000 places 3,8 beds/ inhabitant doctors employees 11

12 THE FRENCH HOSPITAL SECTOR The hospital sector : - Public institutions (1000), - Not-profit institutions (1060) - Commercial institutions, which are known as clinics (800) 12

13 PUBLIC HEALTH INSTITUTIONS The 1,000 French public health institutions account for around 65% of hospital beds (291,500 beds) and outpatient admissions (32,630 places). The public sector includes institutions operating in the patient-care (hospitals), welfare (retirement homes) and medicosocial (specialist care centers) fields. Two main categories of public health institutions: - University hospitals (CHU) - Central Hospitals (CH) and local hospitals 13

14 GENERAL CENTRAL HOSPITALS: 611 INSTITUTIONS Central hospitals : 160,000 beds with 11,500 day beds. The central hospital is responsible for the local population. Following a stay in hospital, it provides followup and rehabilitation treatment (SSR) and long-term treatment. 611 institutions : - 91 institutions specialized in psychiatric care other institutions perform medical, surgical and obstetric work. 14

15 32 UNIVERSITY HOSPITALS (CHU) over 200 hospital complexes almost 3,000 services or departments a capacity of 80,000 beds around 7,000 out-patient places = 35% of the French public hospital sector activity. They perform a triple role: PATIENT CARE, TEACHING AND RESEARCH. 15

16 CHU 16

17 CLERMONT FERRAND ANGERS LYON NIMES GRENOBLE STRASBOURG 17

18 CHU S HEALTH ACTIVITIES health activity (millions) 2009 hospital stays > 24 h hospital stays < 24 h sessions day care surgeries deliveries ER visits 3.57 consultations

19 CHU S TEACHING ACTIVITIES teaching activity 2009 faculties of medecine 36 faculties of pharmacy 24 faculties of odontology 16 first year medical students other medical students interns nursing students paramedical schools

20 PRIVATE INSTITUTIONS Private hospital sector : - 1,860 institutions, providing around - 157,000 beds - 20,500 day-care places Among private institutions, a distinction is made between those that aim to make a profit (clinics) and those with no commercial aims, which usually contribute to the public hospital service. 20

21 THE DOCTORS 95,000 salaried doctors, almost 90% work in the public sector 4,400 doctors in clinics in the private sector 10,900 practitioners in private not-profit institutions. Public hospitals allow their doctors to work on a partprivate basis within the actual institution: this is the case for a third of them. In teaching hospitals, practitioners have a dual status in order to fulfil their teaching and research mandates (PU-PH : University Professors-cum-Hospital Consultants) 21

22 MAJOR CHALLENGES 22

23 MAJOR CHALLENGES Allocation of funding Medical demographics Health inequalities Ageing population Cooperation tools Research and innovation 23

24 ALLOCATION OF FUNDING Health insurance system s deficit : 5,5 billions in

25 MEDICAL DEMOGRAPHICS 25

26 HEALTH INEQUALITIES - Social inequalities - Geographical inequalities - Environmental inequalities = health inequalities 26

27 POPULATION AGEING 27

28 POPULATION AGEING 28

29 COOPERATION TOOLS Public health cooperation - CHT : local hospital communities (co-operation between public institutions) - GCS : Public Health Co-operation Groups (co-operation between public and private institutions) Networks between hospitals and private doctors in order to improve the coordinated treatment path 29

30 RESEARCH AND INNOVATION 30

31 RESEARCH AND INNOVATION AT LOCAL LEVEL In terms of treatment innovations and human trials, university hospitals rely on the expertise of the French National Health and Medical Research Institute (INSERM) and benefit from a recognized multi-disciplinary network: clinical research teams and centers, partnerships with specialist institutes, cooperation with the INSERM and the National Center for Scientific Research (CNRS). As a strategic platform for medical advances, the hospital has become an essential partner for players in the pharmaceutical and biomedical industries In teaching hospitals, practitioners have a dual status in order to fulfil their teaching and research mandates (PU-PH : University Professors-cum-Hospital Consultants) 31

32 RESEARCH AND INNOVATION AT LOCAL LEVEL The organization of clinical research in French teaching hospitals has been profoundly modified over the past 15 years. The first call for clinical research projects was made by the Ministry of Health in 1993 financial effort in favor of clinical research : 50 millions en 2008 for example Major organizational changes in CHUs were made to support this financial effort : - Delegation for Clinical Research (DRC) - Clinical Investigation Centers (CIC)

33 CHU S RESEARCH ACTIVITIES Research activity 2009 publications clinical research studies patients included in clinical research study CHU taking part of a competitive pole 10 University hospital centers are actively involved in medical, dental and pharmaceutical research. 33

34 RESEARCH AND INNOVATION AT A REGIONAL LEVEL In May 2005, seven interregional delegations for clinical research (DIRC) were created to coordinate research activities on a regional basis

35 RESEARCH AND INNOVATION AT A NATIONAL LEVEL Liberties and Responsibilities of Universities (Law LRU) voted in 2007 : 35

36 TO CONCLUDE The French healthcare system is complex, high-performing, complete and currently facing a certain number of challenges. 36