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86 Economic crisis, health systems and health in Europe: country experience
FFS payment levels for certain health professionals, such as radiologists and
pathologists, were decreased in 2011, and official tariffs for laboratory and other
diagnostic tests and services were reduced throughout 2011, 2012 and 2013.
Along with the reduction of drug prices, these measures have formed key elements
in the effort to slow health expenditure and limit the health budget deficit.
Overhead costs: restructuring the Ministry of Health and
purchasing agencies
In 2009, the Health Reform Act created the National Agency to Support the
Performance of Health and Social Care Organizations and Services (Agence
nationale d'appui à la performance des établissements de santé et médicosociaux),
with the mission of helping all health care facilities (both private and
public) and social care providers to modernize their management, optimize
their real estate assets and monitor and improve their performance to control
spending. In addition, a reform to support the pooled procurement of hospital
supplies was introduced in 2011, with the aim of achieving lower prices. Finally,
since 2008, a series of measures have been undertaken by SHI to address fraud.
Provider infrastructure and capital investment
Financed largely through borrowing, €10 billion was allocated to a five-year
hospital sector investment plan from 2008 to 2012, called Hôpital 2012. In
light of the increasing debt levels of public hospitals (Fig. 3.4), 9 the aim was to
maintain the previous level of hospital investment to support regional planning
goals, the development of HTA systems and the updating of safety standards.
The first portion of €2.2 billion was spent in the first three years. In 2013, an
expenditure of €354 million on capital investments in the hospital sector was
planned, with a third of the funds dedicated to improving information systems
to improve efficiency. Concomitantly, in 2013, the European Investment Bank
signed an agreement to invest €1.5 billion in the hospital sector over three years.
Priority setting or protocols to change access, coordination of
care and patterns of use
The 2013 Social Security Financing Law sought to achieve efficiency savings
by shifting care from hospitals to primary and community care settings. In this
context, incentives were put in place to encourage day surgery and hospitalization
at home. Economic evaluations as part of the HTA process became mandatory,
starting in October 2013. In addition, the long-term care programme introduced
in 2012 provided care pathways for certain chronic diseases (including chronic
obstructive pulmonary disease, Parkinson's disease, chronic kidney failure and
9 In France, public hospitals account for three-quarters of acute medical care capacity (80% of medical beds and 70% of
day-care beds) and perform 75% of full-time episodes and 55% of day-care episodes.