JANUARY

FRANCE
inequities in prevention related to obesity, screening, and immunization. A contractual agreement allows for the
use of incentives for physicians practicing in underserved areas, the extension of third-party payment, and
enforced limitations on denial of care.
National surveys showing regional variations in health and access to health are reported by the Ministry of
Health (DREES, 2015).
What is being done to promote delivery system integration and
care coordination?
Various quality-related initiatives aim to improve coordination of hospital, out-of-hospital, and social care (see
above). At the regional level, telemedicine pilot programs are under way to coordinate health and social care
services for target populations identified by the Regional Health Agencies, such as infants, prisoners, and
persons with disabilities. Funding streams are pooled and earmarked for these pilots, and assessment is
planned for 2016.
What is the status of electronic health records?
A high-level electronic health record (EHR) project is currently being implemented across the entire country.
Approximately 551,000 patients, or 0.8 percent of the population, have an EHR, and an estimated 600 hospitals
and 6,000 health professionals use them. Hospital-based and office-based professionals and patients have a
unique electronic identifier, and any health professional can access the record and enter information subject to
patient authorization. Interoperability is ensured via a chip on patients’ health cards. By law, patients have full
access to the information in their own records, either directly or through their GP. All “structured information”
included in EHRs must be communicated, but handwritten notes are excluded. The sharing of information
between health and social care professionals is not currently permitted, but will be tested as part of the PAERPA
program for hospice residents.
A national agency for health information systems was created for the purpose of expanding uptake and
interoperability of existing systems (ASIP, 2014), and the health records are available on a government website.
How are costs contained?
SHI has faced large deficits over the past 20 years, but it fell from an annual EUR10B–12B (USD12.1B–14.5B) in
2003 to EUR6.2B (USD7.5B) in 2014. This trend is the result of a range of initiatives, including a reduction in the
number of acute-care hospital beds; the removal of 600 drugs from public reimbursement; an increase in
generic prescribing and the use of over-the-counter drugs; a reduction in the price of generic drugs; and a
reduction of the official fees for self-employed radiologists and biology labs. Other cost-containment measures
include central purchasing to better negotiate costs, increasing the share of outpatient surgery, and reducing
duplicate testing. Competition is not used as a cost-control mechanism. Global budgets are used only in price–
volume agreements for drugs or devices. As described above, patient cost-sharing mechanisms include
increased copayments for patients who refuse generics or do not use the gatekeeping system (Assemblée
Nationale, 2013).
A number of initiatives to reduce “low-value” care, launched by SHI and HAS, include pay-for-performance to
reduce prescription of benzodiazepines for elderly persons; reductions in avoidable hospital admissions for
patients with heart failure; early discharge after orthopedic surgery and normal childbirth; information on the
absence of the benefit of prostate cancer screening; using DRG payments to incentivize shifts to outpatient
surgery; establishing guidelines for the number of off-work days according to disease or procedure;
strengthening controls for the prescription of expensive statins and new anticoagulants; encouraging the use of
Avastin over Lucentis, and other less costly biosimilar drugs; and testing the use of taxi vouchers, instead of
ambulances, for chronically ill patients (Assurance Maladie, 2015).
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The Commonwealth Fund