QUALITY OF CARE IN THE FRENCH HEALTHCARE SYSTEM

The French health system delivers quality medicine, thanks to the quality of its health staff, subject to a high level initial training and continuing professional education; French medical research is at the forefront of world markets; its efficient care system, both highly regulated and very competitively managed, ensures first rang outcomes.

TRAINING IN MEDICINE IN FRANCE: A SECTOR OF EXCELLENCE

Many students register in Medical School each year, but less than 20% of them will move on past year 1 (pre-Med).

At the end of year 5, they will take the ECN (National Medical Examinations) test that will determine the speciality they may choose to study; a further 4 years for general practitioners, 5 to 6 years for specialists, depending on their ranking in the ECN;

Two metrics attest to the difficulty of these studies: every year many French students choose other European countries where medical schools are easier ; French doctors are welcomed abroad, including in the United States.

Once working, all physicians must participate in continuing professional education (DPC) and France will probably soon join those countries that encourage ongoing knowledge monitoring, key milestones that will decide if a doctor can continue to practice.

MEDICAL RESEARCH IN FRANCE: A KEY POSITION

A recent report by Jean de KERVASDOUÉ, a public health expert and a professor of health economics, quoted the results of a study conducted by a French firm, surveying 250 international experts, including Nobel Prize laureates in medicine.

The results of this study conducted in 2013 show that only the United States are doing better than France when it comes to medical research: out of 380 medical teams assessed France is ranked first 38 times, versus 133 times for the United States, but only 30 for Germany, 22 for Switzerland or 19 for England.

France is at the forefront for several surgery specialties, including shoulder and elbow replacement, hand and wrist, foot and ankle, and spine surgery.

HOSPITAL SYSTEM: A HIGH LEVEL OF BOTH REGULATION AND COMPETITION

Public monitoring applied to all facilities

The monitoring is conducted beforehand, then renewed every 4 years, by an independent, accredited certification body, the HAS (Haute Autorité de Santé ; High Authority for Health industry) .

Care facilities are graded using a 4 letter system from A for the best to D for the lowest ranked.

Special attention is devoted in recent years to the fight against nosocomial infection vectors and each institution must contribute to a database called ICALIN (Composite index of activities in the fight against Nosocomial Infections). The results are published annually and a ranking is attributed. Data are controlled and verified by the ECDC (European Centre for Disease Prevention and Control, based in Stockholm), the European counterpart of the renown US CDC based in Atlanta.

The results of the HAS monitoring are made public on a website (Scope santé), which everyone can access (some expertise is however needed to interpret the information). The results of the ICALIN study are also listed.

Since the accreditation of care facilities takes place every 4 years and the facilities must comply with any comments received before the next inspection, this is considered a permanent and ongoing certification process.

Why HAS certification is trustworthy

HAS itself  is monitored by ISQua (International Society for Quality in Health Care), an international body that overseas healthcare certifiers, like JCAHO in the USA.

HAS gained its second accreditation in 2014, while receiving the maximum rating in 7 standards out of 10

    1. A High level of competition between actors with different status:
      • public: such as CHUs (University Hospital Centres, Public teaching hospitals)
      • private not-for-profit
      • private for profit

      Nearly 1,400 MCO (practicing Medical, Surgical and Obstetrical procedures) institutions are listed in France, most of them with a fairly complete range of disciplines.

      Amidst these competitors, the private for profit sector is gaining momentum. Large groups, some of them with an international reach, able to heavily invest in new technologies, have been created recently. These groups represent almost 50% of the ambulatory care.

    2. Free access to care for the insured
        • No obligation to use any particular care provider
        • No or very small waiting lists

      The French health care system has long achieved its objective of covering the entire population  and allowing access to care, at the patient’s choice without a waiting list. Above all, this freedom of choice strengthens the competition between institutions, directly impacting their level of activity.

    3. Unique, common state-controlled “reporting” system


      For all stakeholders, the PMSI (Medicalization Programme for Information Systems) which is mandatory for all, allows comparison of their level of activity in each discipline, and the quality of care. Combined with the financial data issued from the National Health Insurer, this system ensures that the performance of the stakeholders can be compared, based on unique, objective and reliable data.
    4. Permanent effort to improve the functioning of the system

France adopted the principles implemented in most advanced countries, like the United States: a gigantic effort to categorize and uniquely identify all medical activities (unique coding for all medical services and surgical procedures – CCAM) ; the use of  DRGs, in a much more detailed version than the initial American model system ; P4P (Payment for Performance), increase in ambulatory care, eased by the use of minimally invasive surgery, enhanced recovery after surgery (ERAS), etc. and All of these contribute to the permanent search for the best system, combining the best delivery and outcomes of care, with the most efficient use of resources.