In October the French government presented the major lines of its 2011 “budget project” for social security, to be voted on in November. This budget presents the major strategies for reducing the deficit, which is estimated to reach 23 billion Euros in 2010. Statutory Health Insurance, which is a major contributor to this deficit, is expected to save 2.5 billion Euros in 2011. To achieve this, the law targets the pharmaceutical industry but also complementary insurance funds and patients.
In 2008 the National Sickness Fund piloted a chronic disease management program called “Sophia” in order to improve coordination and quality of care for diabetic patients. In November 2010, the program was extended to further regions. It gives support to diabetic patients already diagnosed and identified through the sickness fund database. The interventions are tailored to suit the individual needs of patients and rely mainly on nurses working in call centres.
In 2009 the National Health Insurance Fund introduced a new contract for generalists, offering additional payments based on their performance against a list of clinical targets. A year later, the first results suggest that the impact of this contract on GP practice has been positive yet marginal. Overall one third of the eligible generalists have signed the contract until now. Two thirds of those who signed receive a remuneration, amounting on average to 3000 Euros, end of the first year.
Activity based payment (ABP) was first introduced in 2004/2005 to pay for acute care services with the objectives of: improving efficiency; creating a “level playing field” for payments to public and private hospitals; improving the transparency of hospital activity and management; and improving quality of care. So far, ABP does not appear to have achieved any of its announced objectives. Results from recent evaluations are presented and discussed.
The current government has committed to the development of new practice structures in primary care which will give more emphasis to prevention and care coordination. The 2007 Social Security Financing Bill scheduled a period of five years from January 2008 for experimentation with supplementary or substitutive remuneration schemes to fee for service in primary care. Group practices will choose among different remuneration packages for providing specific healthcare services.
In the framework of the recent law on new regional health governance adopted in July 2009, the government decided to generalize skill mix initiatives (i.e. cooperation between health professionals) depending on the approval of ARH (Regional Health Authority). The resistance from health professionals to any change in the regulatory framework for skill mix, through national recommendations, led the government to develop a bottom-up process for change based on local practices.