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Chapter 3 | The impact of the crisis on the health system and health in France
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chronic heart failure) and working documents on the improvement of care
organization for older people in 2013. DMPs have also been implemented. A
voluntary DMP for diabetic patients was introduced in 2008 as a pilot project
and by 2013 had 500 000 participants. A similar programme has been developed
for patients with asthma. Finally, new case management programmes seek to
facilitate home care after hospital discharge for childbirth or heart failure.
Health promotion and prevention
In 2011, 2012 and 2013, new taxes (or increases in existing taxes) were put in
place for tobacco, alcohol and energy drinks (see section 3.1).
Fig. 3.4 Debt rate of public hospitals in France, 2002–2010
50
45
Debt rate (%)
40
35
30
2002 2003 2004 2005 2006 2007 2008 2009 2010
Source: DREES, 2012c.
4. Implications for health system performance and
health
4.1 Equity in utilization and financing
As a result of the incentives that have been put in place, there has been a
rapid increase in the number of at-home hospitalization days (119% between
2005 and 2010), although this still accounts for only a small percentage of
hospitalization days (Durand et al., 2010).
Overall, increasing cost-sharing within the SHI system implies two things:
increased reliance on VHI and decreased utilization of care. In 2009, it was