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French healthcare is, for the most part, globally recognized as an efficient system and was even ranked 1st in the world by the WHO in 2000. The Covid-19 crisis highlighted many of its positive attributes, such as its ability to allow private and public actors to work together or the remarkable engagement of its frontline workers. However, like many countries in the wake of the pandemic, the French healthcare system is facing many challenges. The crisis also shed light on some of its weaknesses, in particular the urgency to create more fluid patient pathways.
The French healthcare system remains very much focused on hospitals and curative care. However, there is a proliferation of sanitary, social and medico-social structures, all of which have difficulties coordinating with each other. This has a major impact on patient pathways that are often complex and hard to navigate. With the upcoming French presidential elections as the ideal springboard for this agenda, Institut Montaigne published a note that puts forward a set of recommendations on how to improve patient pathways.
Despite constant efforts over the last few years to put in place better coordinated and patient-centered care practices, patient experience often remains complex and hard to manage. Health professionals are becoming increasingly specialized, which has multiplied silos in care practices and the number of healthcare providers a patient is required to see. For instance, a patient suffering from a long-term psychiatric illness will have to see 11 practitioners on average. That number creeps up to 13-24 for someone suffering from a stroke, and up to 30 for someone with Parkinson’s symptoms.
This lack of coordination has major consequences. Firstly, preventable medical errors cause thousands of deaths each year. Coordination and information transmission flaws between professionals are at the heart of these tragic events and cause both a loss of time and energy for health professionals, not to mention lost chances for patients.
Secondly, these organizational issues negatively impact healthcare spending. While 11.2% of French GDP is allocated to healthcare, one of the highest globally, 20% of healthcare spending is generally wasted by OECD member countries. Yet, a 2010 study showed that a better coordination of patient pathways could save up to 40% of the resources allocated to chronic diseases in the US.
One of the main factors behind these maze-like patient pathways are epidemiological changes in the French population, which have led to an ill-fitted delivery of healthcare. The healthcare system was designed primarily for the treatment of acute illnesses, usually cured after one medical procedure, and is therefore largely centered around the hospital. Yet, chronic diseases have become extremely frequent and usually require the intervention of multiple healthcare providers. This is a consequence of both an ageing population, as today up to 20% of the French population is over 65 years old, but is also tied to longer lifespans, thanks to improved therapeutic care.
French people now suffer from around one or two illnesses, but live longer lives.
As a result, French people now suffer from around one or two illnesses, but live longer lives. Almost 11 million of them receive public health insurance specific to long-term illnesses, compared to "only" 6 million in 2004. This makes orientation worryingly difficult for the patient within the system.
Another key factor is a change in the expectations of patients, as they become increasingly engaged in their own care. Yet, they remain largely excluded from the management and organization of their care path. A key solution to allowing patients to be more involved in this system is the introduction of quality indicators. In France quality of care is often measured through processes and available resources rather than clinical outcomes or patient experience. This idea is largely shared by the French population, as 90% of patients believe that the publication of care quality indicators would be a good asset for both care facilities and private practitioners. Moreover, it is essential that patients be included in the development of these indicators. While this is rarely the case in France, it is common practice in several countries like the UK where the Patient Reported Outcome Measures are designed to evaluate care quality from the patient’s perspective.
The crisis has offered some unprecedented solutions. Most of them have been brought about by an increased use of technology in healthcare, which has skyrocketed since the start of the pandemic thanks to private actors and civil society.
As a result, several innovative solutions have been developed or popularized including telemedicine, online follow-ups, appointment scheduling online platforms, chatbots and other digital apps, as well as AI and self diagnosis. According to French Social Security, the number of online consultations was multiplied by 40.4 between February 2020 and 2021. Some telemedicine platforms were also selected by French authorities to serve as online platforms for vaccination bookings. As such, in March 2021, over 71% of French people reported having used an online appointment scheduling platform. The French have welcomed these innovations with open arms: 86% of them believe that E-Health is a positive improvement and 3 out of 4 people believe they will have a positive impact on their own care.
Digital solutions can help make patient pathways easier to navigate. This is not only beneficial for patients, who will not have to choose between a sea of providers, but also for professionals. Firstly, E-Health can facilitate a more personalized prevention. This would involve therapeutic education for the sick to better understand their illness, targeting populations at risk based on aggregate data, as well as those susceptible to relapse. E-Health should furthermore make transparency data usage a priority.
Technology in healthcare [...] has skyrocketed since the start of the pandemic.
Secondly, it can promote better access to the right care, at the right moment. E-Health makes it easier to link citizens with available health professionals via online appointment scheduling platforms and online consultations. However, there are two implications that need to be considered here. On the one hand, access to appropriate care, and both clear and transparent information on the quality of the available offer need to be guaranteed. On the other hand, computer illiteracy should also be accounted for, as it concerns about 17% of the French population today and could further estrange some patients.
Thirdly, patient pathways need to be decompartmentalized and the silos between GPs and private clinics, hospitals, and the medico-social domain need to be broken. Technological innovation can thus help enable easier and safer peer communication and information sharing, so all actors can have access to the right data at the right time. It can also help professionals prioritize actions as well as limit their administrative load. The French government has already started taking initiatives in this direction with the Espace Numérique de Santé (the Digital Health Space). This platform will be launched in 2022 and will include a catalogue of referenced telehealth apps, access to citizens’ Dossier Médical Partagé (Electronic Health Record), a secured chatbox, as well as a calendar.
Lastly, e-Health can help empower today’s new "active patients". Connected tools and personalized solutions have already been developed to allow patients affected with chronic illnesses to follow the evolution of their disease, as well as to be coached and receive remote follow-up between consultations. Very few digital solutions are being evaluated today and we know little about their effectiveness. This could discourage health professionals from recommending these apps to their patients. An initial evaluation baseline has been produced by the French High Health Authority, but more remains to be done.
Moving forward, Institut Montaigne recommends that the focus of French health authorities should be to put human resources at the center of the transformation of patient pathways and prioritize the quality of care services by increasing investment in human capital. Health authorities should also increase investment in digital innovations in order to facilitate access to secure and interoperable health data, as well as to solutions adapted to the needs of patients.
Co-authored with Emma Ros, Policy Officer, and Kenza Sabri, Assistant Policy Officer.
Copyright: PIERRE-PHILIPPE MARCOU / AFP
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