Access to Health Care for Adults in France Isabelle Durand-Zaleski

Isabelle Durand-Zaleski Overview Entire population covered for healthcare Rate of coverage varies by type of care (e.g., from 80% for hospital admissions to 15% for lifestyle drugs) 95% of the population has complementary insurance, which can be state-sponsored Public/private mix of service provision, extra billing is permitted 2016 International Health Policy Survey Webinar | May 18, 2017

Current Health Situation Isabelle Durand-Zaleski Current Health Situation 15% adults report a serious chronic condition and are therefore eligible for full health care coverage for that condition An additional 5% report a health problem 2016 International Health Policy Survey Webinar | May 18, 2017

Isabelle Durand-Zaleski Affordability In theory affordability should not be an issue, but some problems remain: Chronic conditions coverage: for a prespecified package and NOT for situations that are unrelated to the condition Extra billing Glasses and hearing aids Dental care 2016 International Health Policy Survey Webinar | May 18, 2017

Quality of Coverage by Income Level Isabelle Durand-Zaleski Quality of Coverage by Income Level State-sponsored 2016 International Health Policy Survey Webinar | May 18, 2017

Out-of-Pocket Payment, by Age, for Low-Income Patients Isabelle Durand-Zaleski Out-of-Pocket Payment, by Age, for Low-Income Patients 2016 International Health Policy Survey Webinar | May 18, 2017

Isabelle Durand-Zaleski Access to Care Insufficient supply of doctors in small towns and rural areas: Current experiments: Financial incentives Medical homes Doctors from other EU countries Task shifting: nurses, pharmacists Emails The issue of payment is not solved 2016 International Health Policy Survey Webinar | May 18, 2017

Isabelle Durand-Zaleski Access to Specialists Geographic or for specific populations: telemedicine experiments in every region eg the Paris region Elderly persons in nursing homes Neonates Prisoners 2016 International Health Policy Survey Webinar | May 18, 2017

Patient Education Programmes Isabelle Durand-Zaleski Patient Education Programmes Strictly defined and controlled Validation of content by the National Health Authority and specific reimbusement schedule Ensures that programmes are evidence-based BUT may send to GPs the message that patients’ education is to be left to specialists 2016 International Health Policy Survey Webinar | May 18, 2017

Isabelle Durand-Zaleski Care Coordination A major issue, and has been for many years few incentives Governance gap: medical \social Hospital \ office-based physicians 2016 International Health Policy Survey Webinar | May 18, 2017

Developing internal coordination among teams of primary care providers Isabelle Durand-Zaleski Developing internal coordination among teams of primary care providers health centers (centres de santé; CDS) that bring together salaried professionals multidisciplinary health homes (maisons de santé pluriprofessionnelle; MSP) where the professionals are self employed 800 MSPs and 600 CDSs that account for just over 10% of GPs 2016 International Health Policy Survey Webinar | May 18, 2017

The implementation of territorial support platforms Isabelle Durand-Zaleski The implementation of territorial support platforms By region, at the request of healthcare professionals information and referral of professionals to the available health, social and medical-social resources in the territory using a dedicated telephone number; support for the organization of complex pathways for a duration that is adapted to the needs of the patient, within a framework inspired by “case management.” 2016 International Health Policy Survey Webinar | May 18, 2017

Support for professional practices and initiatives Isabelle Durand-Zaleski Support for professional practices and initiatives Operator Component partner partner partner Operator: region Components: local netwoks, local iniatives Partners: remote resouces eg nursing homes, social services 2016 International Health Policy Survey Webinar | May 18, 2017

Programmes for elderly patients Isabelle Durand-Zaleski Programmes for elderly patients Implemented in 2014 in nine pilot regions in France Includes persons aged over 75 years, high risk of loss of autonomy: patients at home: fragile, prescription of certain classes of drugs, or presence of one or more chronic condition; hospitalized: admitted to the hospital via the emergency department. Institutionalized: residential care homes for disabled frail elderly 2016 International Health Policy Survey Webinar | May 18, 2017

Isabelle Durand-Zaleski Conclusion Current coordination experiments respond to: the diversity of professional practice the needs of the users of the French health system. organize scaling up at the territorial level based on the subsidiarity principal principle national coordination by the Minister of health capitalization among the regions. 2016 International Health Policy Survey Webinar | May 18, 2017