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What to Expect French Healthcare in 2022

ARTICLES - 7 February 2022

For more than two years, Covid-19 has been raising key questions about our attitudes towards health, and our broader expectations of the healthcare system. According to a recent poll by IFOP, a leading French polling institute, 74% of French people think that the quality of the healthcare system has deteriorated over recent years. This represents a stark contrast to 2007, when only 57% held this view. Moreover, 37% of French citizens feel that they are living in a "medical desert", a term used to describe regions where populations struggle to access adequate healthcare. Indeed, more general practitioners are currently retiring than entering the job market, which has undoubtedly exacerbated this trend. 

With the French presidential elections scheduled for April 2022, addressing these issues should be a strategic priority. Despite this, 8 out of 10 French citizens currently believe that the topic of healthcare is inadequately covered by candidates. At the same time, more than two-thirds of French voters say that healthcare will be a determining factor for their decision in April. 

Within this context, Institut Montaigne has recently published an assessment of President Macron's healthcare policies during his mandate, and has laid out recommendations on how to transform the French healthcare system in the next five years. This article identifies four priorities in the field of healthcare.

Making patients key actors in the healthcare system

Equal access to healthcare is an integral part of French democracy and a founding principle of France’s healthcare system. The prerequisite for this is access to clear, cohesive and transparent information. Yet the lived experience of the French suggests that this is not the case. The sentiment of living in a "medical desert" contrasts with statistics which show that only 10% of the population lives in an area with limited supply of healthcare services. This discrepancy largely reflects the organizational flaws of a healthcare system that has simply become too difficult to understand. 

To ensure that information is transmitted effectively, the French healthcare system should develop indicators to measure the quality of care. These indicators are already in use in many English-speaking countries. They are mandatory for four major pathologies within the NHS (the UK’s healthcare system), including: knee surgery, hip surgery, varicose vein surgery and hernias. International models allow us to identify several types of indicators: those that assess the impact of medical care on the quality of life (PROMs) and those that concern the impact on the health status of patients (CROMs). Other indicators consider the way in which patients experience care (PREMs). Such initiatives support the development of a patient-centered approach to healthcare.

While indicator use is not widespread in France, there is a strong demand among patients: 86% of patients say they would be willing to evaluate their care, if the results could help them choose their healthcare professional. The French National Authority for Health (HAS) is currently updating its methodology and data collection. A new website with evaluations will go live this spring. 

Betting on innovation 

Following the global trend, the development of e-health services is on the rise in France as well. Due to the Covid-19 crisis, the use of telehealth has increased by 40% year-to-year. This trend towards digital health had been well underway throughout Macron’s mandate. The government has launched several initiatives to help the development of telehealth, such as the Ministerial Delegation for Digital Health (DNS) or the "Mon Espace Santé" (My Health Space) platform. The platform has just become available this year and includes shared medical records, a secure messaging system between patients and healthcare professionals, a health diary and a catalogue of state-certified applications. 

Digital healthcare represents an effective tool to mobilize patients and healthcare professionals around a shared vision of care.

Digital healthcare represents an effective tool to mobilize patients and healthcare professionals around a shared vision of care. Features like online appointment booking or remote consultations simplify access to healthcare for patients. For example, applications to monitor chronic diseases enable patients to actively monitor their own health. By optimizing administrative processes, e-health saves time, allowing health professionals to provide quick and reliable diagnoses.

At the same time, online health services guarantee increasingly personalized healthcare. However, to make e-health available for all, increasing digital literacy will be crucial. Currently, 17% of the French population have insufficient digital skills, compared to only 10% of the British population. 

The French healthcare system is financed by a social security system, which holds a deficit that amounted to 1.7% of GDP in 2020. In 2024, this deficit is estimated to represent more than €15 billion. Today, innovative drugs allow patients to "live with" certain diseases that were, until recently, considered incurable. Yet many of these drugs are expensive, and their arrival on the market raises concerns about the French government’s ability to regulate prices while guaranteeing access to all patients. These concerns appear to be well-founded, since France currently ranks 21st in Europe for the average time to market new products, placing it well behind its German (1st), British (7th) and Italian (10th) neighbors. The CSIS (the Strategic Council on Health Industries) 2021 and the Plan innovation santé 2030 (the 2030 Health Innovation Plan) have been welcomed by healthcare stakeholders as a sign of the government's determination to make this issue a strategic priority. 

A new governance for the French healthcare system

Despite a trend towards decentralization, the central government still makes most of the decisions in France. However, state ministries are often out of step with specific regional needs. While regional health agencies in France play a role in steering the health system, they are not yet sufficiently involved in defining and directing public health policies. 

States like Quebec have gone a step further by implementing the principle of "population responsibility". This aims to make public and private actors responsible for improving the health and well-being of their population. In France, this approach could provide a solution to the fragmentation of the healthcare system. It makes it possible for healthcare professionals to better define and communicate their care pathways. 

With more than 2 million employees, the healthcare sector plays a significant role in wealth creation, particularly with regard to the MedTech industry and the application of digital technology to healthcare. There are several major French players in regional health innovation: Grand e-Nov in Eastern France, Eurasanté in the Hauts de France region, and the recently inaugurated PariSanté Campus in the Paris region. Despite this dynamism, (or perhaps, because of it), the healthcare sector still operates in silos. Therefore, the new Health Innovation Agency aims to create a scorecard integrating health, organizational and economic indicators. This would improve the overall coordination and the management of the system.

The healthcare sector plays a significant role in wealth creation, particularly with regard to the MedTech industry and the application of digital technology to healthcare.

Preventative politics for Mental Health and Aging

Given its low investments in preventative healthcare, it is likely that France will accumulate risk factors in comparison to other OECD countries. Two priority areas stand out in this regard: mental health and aging. 

The Covid-19 crisis has had major consequences for mental health in France, as depressive disorders doubled between September and November 2020. Even though psychiatry represents the largest expenditure for the French health insurance system, patients are still poorly diagnosed and often treated too late. General practitioners should be more involved in the early detection of psychological disorders. Indeed, 60% of consultations for psychological disorders are done in primary care medicine. To that end, better training is needed for general practitioners.

Regarding the second priority, aging, French society faces several challenges. France has experienced a sharp increase in its aging population over the last thirty years. Today, 20% of the French population is over 65 years old. Nearly 70% of the over 85 year olds suffer from at least one chronic disease. Although life expectancy in good health has increased over the last decade, the figures are not distributed evenly. The loss of autonomy and life expectancy at birth without disability remains lower in France than the European average. In order to promote "active aging", the French healthcare system must adapt to better meet the needs of seniors. This could be realised by, for instance, encouraging the development of mechanisms that allow seniors to maintain independence, or through targeted prevention policies.

In sum, the Covid-19 crisis has revealed profound weaknesses within the French healthcare system. Yet it has also provided new and unique opportunities to invest in innovative technologies that will prioritise patient-doctor relationships, and make healthcare more accessible. Going forward, the government should give precedence to implementing care indicators, digitizing health services, restructuring the governance of healthcare, and investing in long-term preventative policies. Making healthcare a strategic priority will be a determining factor of both the upcoming elections in April 2022, and the subsequent success of the new government. 

 

Co-authored with Laure Mourgue d’Algue, Assistant policy officer.

 

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