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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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 s
The issue of payment is not solved
2016 International Health Policy Survey Webinar | May 18, 2017

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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