Healthcare in France: A policy analysis
The healthcare policy in France is led by the Minister of Solidarities and Health, Agnès Buzyn. It stems from the vision shared by Ms. Buzyn and Emmanuel Macron of a financially-balanced, fairer and prevention-oriented healthcare system.
The previous Minister of Health, Marisol Touraine, has been considered unpopular by some, with a majority of health professionals siding against her and the reforms she undertook. Thus, Agnès Buzyn had both a personal and a professional responsibility to propose policies that would suit health professionals and reconcile them with the government, while satisfying the industry and patients at the same time.
For this reason, the presentation of the National Health Strategy (SNS), the first major healthcare statement of the government, was a major stake for her term-in-office. The SNS incorporates a vast number of governmental actions to create a comprehensive approach to health and healthcare. It is based on five main pillars, which are the implementation of a policy promoting prevention for all, at all ages and from all social backgrounds, the reduction of social and territorial inequalities in access to healthcare, the quality, safety and relevance of healthcare and the pursuit of innovation to transform our healthcare system.
The preventive approach : an effort to reduce healthcare expenditures
“An ounce of prevention is worth a pound of cure”. Some attribute this idiom to Benjamin Franklin, presumably about fire safety. It does not take away the fact that it has become extremely relevant to consider its application to healthcare.
Preventing a disease is better than curing it. This is the key assumption to the prevention policy Agnès Buzyn and her fellow Ministers from the government have been implementing, in line with the policy of Marisol Touraine. Be it in public health with the Prevention plan presented by Édouard Philippe in March 2018, the Prevention plan against poverty and its consequences announced by Emmanuel Macron or the bill expected for 2019 carried by Muriel Pénicaud on health at work, those documents all include prevention-related measures.
The objective is simple : reduce healthcare expenditures by reducing the exposition to risk factors before they start having an effect on public health.
Quality, safety and relevance, must-haves for an appropriate healthcare
Even though healthcare safety had been de-prioritised since the beginning of Ms. Buzyn’s term, the new focus on prevention has brought back these issues of healthcare quality, safety and relevance.
The quality of healthcare, especially in the hospital, has suffered from the increasing number of patients and the scarcer resources allocated to healthcare supply. Emergency rooms are crowded with patients, medical doctors are deserting the countryside to reside in cities, and it hinders on the quality of healthcare : health professionals have less and less time, materials and tougher conditions to work in.
Patients’ safety is thus at stake. This is a reassuring fact: working on the former will help with the latter. By improving work conditions for health professionals in the hospital and relieving the pressure by creating “new” professions, such as the Advanced Practice Nurse (IPA), the government is hoping to make medical practices safer.
The relevance of healthcare will also help in reducing the expenditures of the system. The government intends to reform the funding system, currently rewarding medical acts instead of payment bundles which would encapsulate the whole care-pathway of the patient. This will certainly help in encouraging innovation as well, by providing enticing funds to actors who try to bring breakthrough technologies to the market.
Healthcare, innovation and competitiveness
Innovation is valued by the government as a source of healthcare relevance and competitiveness. The 2018 Social Security Budget Law emphasised the importance of innovation and experimentation through an article, article 51, which allowed experimentations to be put together while not being compliant with the current financing and organisational modes. This would permit out-of-the-box, forward-thinking experimentations to take place, and find new ways to improve the health system. To ensure the relevance of those experimentations, Agnès Buzyn also installed a Strategic Council for Health Innovation on April 5, 2018.
This first step was followed by several announcements from Agnès Buzyn and Emmanuel Macron, claiming that the health system had to evolve to adapt to societal needs. It paved the way for the National Health System Transformation Strategy, announced officially on February 13, 2018. This strategy put on the table five needs to address thanks to innovation in all its forms: quality and relevance, financing and remuneration, digital health, human resources and territorial organisations.
As soon as April 2018, the government started institutional consultations with stakeholders, to be able to launch, in September, the “My Health 2022” plan. In parallel, the Strategic Council of Healthcare Industries, a meeting between the Prime Minister Édouard Philippe and major pharmaceutical companies in France, occurred on July 10, leading to recommendations from the PM to reform early access to, and the pricing system of, medicines, to give more predictability to the industry and to develop an incentive framework which would attract new players in France and encourage innovation.
The financial feasibility of the healthcare strategy: the Social Security Budget Bill
September, October and November are traditionally the months when the budget is defined. The commitments of the government regarding the healthcare policy are translated into legislative material when the time of the Social Security Budget Bill comes. The 2019 PLFSS effectively transposes measures addressing prevention, quality, safety, relevance of healthcare, and innovation is strongly affirmed through several items fostering early access and giving more freedom to industrials.
This year, the examination of the text started on the 16th of October in the National Assembly, and the text was adopted on October 30. It is not over yet, as it now needs to go through in the Senate, where it receives additional amendments. The final vote should occur shortly, on November 19, at the end of the examination in public session in the Senate, assuming there’s no need for a mixed committee comprised of the parliamentarians from the two Chambers. It seems almost certain, though, that the government will be quite successful in its effort to create policies that match its orientations.
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