Context
1100 French hospitals will be re-organised in approximately 150 territorial hospital groups (groupements hospitalier de territoire, GHTs), according to their geographic location. The GHTs will formalise the various partnerships between hospitals and will change dramatically hospital markets, transforming how hospitals function.
Impetus for the reform
GHTs constitute one of the key provisions of the Law of 26 January 2016 (article 107) on the modernisation of our health system (see Health Policy Update 02/07/2015), which was presented by the current Ministry of Health as an “innovation that will strengthen the public hospital service”. The GHTs are considered channels to encourage cooperation between health care facilities, to improve the management of resources and, ultimately, to downsize the hospital sector, which represents a higher share of health resources compared to other OECD countries.
Policy process
Each regional health agency (agence régionale de santé, ARS) defines the composition of GHTs in their area. A specific decree of 27 April 2016 provided the rules for creating GHTs, the governance arrangements to be followed by each group, as well as the scope for pooling functions and activities for implementing a "shared medical project", which will detail the organisation of care for patients by medical specialty. The decree defines a gradual deployment of GHTs to enable facilities to build medical projects on all of their activities. However, it does not provide an indication on the size of GHTs nor the rules for selecting hospitals to work together.
As a starting point, the support or lead facility, nominated in the agreement, will provide a number of functions on behalf of the hospitals included in the group. For example, hospital information systems, the purchasing function, the coordination and development of medical and paramedical training and the continuous professional development of staff will be centralised.
The ARSs were provided three months to define the GHTs in their region (until July 2016). Despite this short time, the deadline was met and 135 GHTs were officially set up in July 2016. However, it is difficult to see the consistency and logic in the composition of GHTs across ARSs. The 135 GHTs are highly variable in nature, ranging from 2 to 20 facilities, and covering from 50,000 to over 2 million inhabitants. Each ARS seems to have its own logic: while some ARSs appear to exploit actual hospital markets (hospitals’ catchment areas) in creating new hospital groups, others use simply administrative borders (department) as units for grouping hospitals, ignoring completely the actual patient move across hospitals and how hospitals compete and collaborate.
To be functional, the GHTs are expected to define concrete projects specifying shared medical services. This work can lead, for example, to the creation of 'territorial medical teams’ (shared between hospitals), advanced medical consultations or joint investments in telemedicine. The GHTs are not expected to be fully operational until 2018 or 2020 in some aspects.
Evaluation
From the current situation, the objective of integrating all public hospitals seems to be largely completed, despite a few exceptions. Very few private hospitals (profit and non-profit) and nursing homes have joined in GHTs until now. However, for GHTs to improve care coordination and pathways of their patients, the collaboration with these structures as well as primary and social care providers may be essential. In any case, it is very early to conclude to what extent the GHTs will improve the efficiency of the hospital sector and whether there would be any perverse effects in terms of access to health care.