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The French Brief - The New Frontiers of Healthcare

The French Brief - The New Frontiers of Healthcare
 Laure Millet
Fellow - Healthcare

In November 2020, 2 out of 3 French people believed that the utmost national priority was to limit the spread of the Covid-19 pandemic, even if doing so had a negative impact on the country's economy and employment rate. This statistic illustrates a drastic reversal of the hierarchy of political norms that is taking place in France. Rather than placing health and economics in opposition to each other, this crisis may succeed in making public health a global political criterion that integrates economics, social justice and ecology. 

Institut Montaigne published a paper titled Filière santé: gagnons la course à l'innovation (The Healthcare Sector: Winning the Race for Innovation), which aims to provide recommendations for structuring the healthcare sector in France. This study comes at a pivotal moment: while healthcare was not a central theme in the last presidential campaign in 2017, the issue has certainly saturated the media and political landscape during the Covid-19 crisis. Although public and private actors in the healthcare sector have shown a strong capacity for resilience and commitment during this crisis, several important shortcomings have also become apparent. 

The Covid-19 crisis: revealing the need for better structuring of healthcare actors

If the public hospital crisis had already become part of French public debate in 2019, the first months of Covid-19 brought a number of other issues to the forefront. These include a shortage of caregivers, limited reception capacities of the emergency and resuscitation services, gaps in the supply of equipment (masks, medical gowns) and health products (anaesthesia products, oxygen). More recently, France has also failed to keep up in the race for vaccines and treatments against the virus. Here again, the crisis shed light on the challenges the French industrial and research ecosystem faces.

The Covid-19 crisis has also highlighted the fracture lines and the major silos that persist between the hospital world and primary healthcare services, between public hospitals and private clinics, and at large, between public and private health actors in France. The issue of trust and dialogue between these stakeholders became all the more pressing with the operational blockages and coordination failures in the early stages of the pandemic. 

The Covid-19 crisis has highlighted the fracture lines and the major silos that persist [...] at large between public and private health actors in France. 

The point is not to undermine the resilience of our healthcare sector in the face of this unprecedented crisis. France was indeed able to adapt its hospital services, develop telemedicine, rapidly redirect research efforts in all areas, find solutions for storing and increasing vaccine production capacities, and so forth. Instead, the objective is to highlight the opportunity to better structure the healthcare sector in France, so as to prepare for the "new world". This begins with the joint construction of a strategic vision and the establishment of conditions for its management - including both the public and the private players. 

Healthcare: a dynamic sector creating wealth and growth

Defining the "healthcare sector" is not an easy task. It brings together activities and actors that are far more diverse than in most other sectors of the economy. In the broadest sense, this sector can be defined as all the activities of public and private players who contribute to the production of a service or product with a health-related purpose. These activities necessarily lead to the creation of value (direct and indirect employment, production of knowledge, medical and scientific progress, etc.). Healthcare brings together a diversity of players such as providers, manufacturers, payers, healthcare services, digital and diagnostic companies, etc.

Healthcare is a leading economic sector in France. Firstly, because it employs more than 2 million people. Secondly, because it creates wealth. This can be particularly observed in the health and technology industries, but also increasingly where the digital sector applies to health, which is expected to grow exponentially in the coming years. In total, the economic weight of the sector represents nearly 300 billion euros (healthcare expenditure and exportations), or 12.3% of French GDP. Thirdly, because it is one of the few sectors to invest massively in research and development (8.5 billion euros invested in R&D by the public and private sectors) and to make a positive contribution to France's trade balance.

Innovation, governance and data: the cornerstones of the healthcare system’s future 

A real paradigm shift is needed as to the way France’s healthcare system is currently managed. This new paradigm must consider healthcare as a productive sector of the economy that generates significant value. It must also conduct health policies capable of both integrating a logic of investment and an evaluation of the return on investment. Finally, it must lay the groundwork for France to build a long-term vision for its healthcare system which aligns and coordinates all the public and private players. A crucial aspect of this will be to rethink in depth the role of the State. Three major axes emerge to help these objectives materialize.

First of all, the governance of the healthcare sector needs to be reinvented (both at the European and national levels) to encourage collaboration between the public and private sectors, while making the system more efficient and relevant. Innovative players in the sector need a single point of contact within the French State - a "one-stop-shop" - to guide them through developing solutions that are in line with major public health priorities. In the context of the future French Presidency of the European Union in 2022, it also seems imperative to put the governance of the healthcare sector at the top of the agenda, in order to enable better response coordination to future health crises.

A real paradigm shift is needed as to the way France’s healthcare system is currently managed [and] consider healthcare as a productive sector of the economy. 

Thus, Europeans must go further and faster in the creation of the Health Emergency Response Authority (HERA) to better coordinate responses to future health crises. 

This can be achieved through policies centered on sharing health data between the different Member States, but also through the development of quality of care indicators from the patient's point of view (PROMS). 

In addition, it is necessary to extend the work on harmonizing market access procedures that has already been undertaken with the European Medicines Agency, in particular by creating the conditions for a European assessment of health technologies (harmonization of methods and criteria, community assessment, etc.).

Next, the French healthcare system must urgently make the shift to a model based on preventative care. France needs to invest massively in prevention and the coordination of care pathways through digital technology. To do this, the development of new financing models is key in order to boost the emergence of platforms that integrate care and collaboration between professionals (financing on the basis of care pathways and performance, development of population-based approaches, results indicators, etc.). 

Finally, it seems essential to develop data-based tools for the sector and for patients. For example, setting up a dashboard for the healthcare sector would make it possible to better manage the system based on a limited number of health indicators (healthy life expectancy, vaccination coverage, etc.), organizational indicators (number of open and active shared medical records, compliance monitoring, etc.) and economic indicators (growth in the number of jobs, R&D investment by public and private players), which would be built and shared by all stakeholders. Similarly to the UN Sustainable Development Goals, these major indicators could serve as a compass for the public and private players within the system. 

The crisis has also shown that it has become imperative to foster the development of digital solutions that improve the quality of care for patients. The events of this past year have shown that the relationship between healthcare and digital technologies is deeply symbiotic: think of teleconsultation, e-prescriptions, contact tracing apps, public health data analysis, chatbots, etc. To this end, mechanisms should be put in place to encourage healthcare professionals to adopt digital practices and devise support programs for actors across the sector.



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