To help patients choose a care facility according to their expectations, it is necessary to measure and evaluate the management of a given disease as well as the good medical practices carried out by an institution or a doctor. Quality indicators are relevant tools to achieve this objective and provide the information French citizens need.
How is the quality of care measured in France?
In France, the High Healthcare Authority (Haute Autorité de Santé or HAS) is responsible for developing quality indicators for our health system. It also collects the near-majority of the measures of these indicators, i.e. about fifty indicators of quality and safety of care, divided into two categories.
These indicators developed in France have two major limitations:
- they are process-related indicators and indicators measuring patient experience and satisfaction following a hospital stay (PREMs) and not outcome indicators focusing on patients' functional score or quality of life (PROMs) and patients' clinical status (CROMs);
- patients’ associations have been weakly included in the choice of quality and safety of care indicators developed by the Haute Autorité de Santé. While patients’ associations have been allowed since September 2017 to contribute to the evaluation of medicines and medical devices for reimbursement within the HAS, they still have a limited presence in the development of quality indicators, the latter therefore do not reflect indicator measures that matter to patients.
According to the Kantar survey, However, there are no tools to measure such information in France.
Who are the right students in this field?
Unlike France, which measures indicators based on the assessment of compliance with processes and not on the outcomes of care provided, foreign initiatives and assessment systems focus more on clinical outcomes and outcomes reported by individuals in terms of quality of life.
In the United Kingdom, the collection of outcome indicators by the National Health Service (NHS), the equivalent of Assurance Maladie in France, is mandatory for four targeted diseases: knee surgery, hip surgery, varicose vein surgery and hernia. 100% of the results collected are published online (My NHS and NHS Choice) and enable English citizens to make informed choices about their hospitals and healthcare professionals based on many quality indicators. The NHS Choice database is very popular and counts 48 million visits per month, thus responding to a real demand (in comparison, the French Health Insurance site "Ameli.fr" counted about five million separate visitors per month in 2016).