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382 Economic crisis, health systems and health in Europe: country experience
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Pharmacist remuneration made independent of sales volume to encourage
the dispensing of cheaper alternatives (2011).
• Reduction of prices for drugs and medical devices (2013).
Salaries and motivation of health sector workers
• Pharmacists' incomes were made independent of sales volume (2011).
• Pay for performance for GPs was introduced on a voluntary basis in 2009
and generalized and expanded as part of the 2012 agreement between SHI
and GPs. It was also included in the 2012 SHI agreement with cardiologists.
• FFS performed by certain health professionals such as radiologists and
pathologists were decreased (2011).
Payment to providers
• Reduction of official tariffs for laboratory and other diagnostic tests and
services (2011, 2012, 2013).
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• 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 médico-sociaux) with the mission of helping health care facilities and
social care providers to modernize their management, optimize their real
estate assets and to monitor and improve their performance in order to
control spending (2009).
• Introduction of a reform to support the pooled procurement of hospital
supplies (2011).
• Tackling of fraud by the SHI funds planned (ongoing from 2008).
Provider infrastructure and capital investment
• Financed largely through borrowing, €10 billion was allocated to a fiveyear
hospital sector investment plan (2008–2012), called Hôpital 2012.
The aim was to maintain the previous level of hospital investment in
order to support regional planning goals, the development of information
technology systems and the updating of safety standards. The first tranche
of €2.2 billion was spent in the first three years.
• Planned to spend €354 million on capital investments in the hospital
sector, with a third of the funds dedicated to improving information
systems in order to improve efficiency (2013).