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16 February 2024 | Country Update
France develops a roadmap for reducing the carbon footprint of its health system
6.2. Future developments
Future developments – whether only discussed or already announced by the government and/or under experimentation – follow the same direction as those detailed in section 6.1, focusing mainly on promoting better coverage and equity, improving access to care and prevention, and continuing the reform of primary care and provider payment.
Improving financial access to care
The law for the financing of the SHI for 2023 included a new financing model for innovative and expensive medications administered in hospitals, to ensure equity in access to those medicines. This includes a risk-sharing model between the pharmaceutical company and the SHI, with two new parameters: payments in instalments, and based on the efficacy of the medication in real life (LOI no. 2022-1616 du 23 décembre 2022 de financement de la sécurité sociale pour 2023, 2022).
Improving training and physical access to care
Starting in 2023, physicians, pharmacists, dentists, midwives, nurses, physiotherapists and podiatrists will be required to recertify every six years. The aims are to improve knowledge, quality of care and relations with patients, as well as professionals’ own health (Ordonnance no. 2021-961 du 19 juillet 2021 relative à la certification périodique de certains professionnels de santé, 2021) (see section 4.2.1).
It is also planned to allow patients to directly access certain health care professionals (nurses, physiotherapists and speech therapists), for whom a prescription by a physician is currently required, so as to improve access and streamline care pathways.
A reform of medical studies for GPs was also passed into law in the financing law of the SHI for 2023, with a fourth year of internship required to graduate (vs three currently), which would need to be performed in an ambulatory care setting, and preferentially in a medically underserved area.
To improve territorial access, there have been multiple attempts to make practising in underserved areas mandatory for newly graduated physicians for a period of three years. However, this proposition faces fierce resistance from health care professionals and is unlikely to be voted into law.
Prevention
The law for the financing of the SHI for 2023 has introduced multiple measures to improve disease prevention. For one, it plans for free prevention consultations starting in 2023 for key age groups: at 20–25 years old for primary prevention to encourage healthy behaviours throughout life, at 40–45 years old for the prevention of chronic disorders and at 60–65 years old for the diagnosis of first frailties or loss of autonomy. Free access to screening of sexually transmitted diseases and free contraception for young women (under 25 years old) were also approved by parliament since 2022.
Funding care providers
As mentioned in section 6.1, multiple reforms are under way regarding hospital funding to diversify their sources of revenue and, in acute care, to reduce the weight of ABP in the overall funding.
In acute care episode-based payments are being piloted for patients requiring hip and knee replacement as well as colectomy surgery in cancer patients. The bundle would cover acute care admissions, SSR, HAD, surgical and anaesthesia consultations, nursing care and physiotherapists for 45 days prior to the intervention and 90 days afterwards (180 days for knee replacement). An increase in existing P4P in hospital payment and the introduction of capitation have also been announced in successive plans but have yet to be formally implemented.
Regarding SSR, the new funding model should include both ABP (50%) and capitation (30%), and other smaller payments for specific activities (research, transformation, P4P, specialized equipment, etc.).
Finally, regarding HAD, there have been calls to reform the nomenclature to better reflect the activities carried out and their costs, which is ongoing. Plans have been announced to include payment for specific activities, in particular for hospitals operating in isolated or socially deprived areas, and incentives to both decompartmentalize its funding from acute care and to encourage GPs to address patients to at-home services directly.
Following the “France – Green Nation” Strategy launched by the Prime Minister at the end of 2022, an interministerial steering committee was set up in May 2023 for reducing the environmental impact of the healthcare sector. The committee brings together the ministries in charge of health, ecological transition, energy and industry, as well as all main stakeholders in the health sector, and will propose an ecological planning agreement, which will be binding on the parties involved. Priorities include buildings and energy management, sustainable purchasing, eco-responsible care, waste management, training and research in ecological transformation, sustainable transport, and digital technology. In line with this roadmap, the Statutory health insurance fund (CNAM) launched in November 2023 a new task force for ecological transition, with the priority to reduce the carbon footprint of medicines. This mission is currently working on developing a method for assessing the carbon footprint of drugs to be considered in the price setting process.
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