The French Healthcare

1
The French Healthcare

• December 2004 Health Valley
• Laetitia Poulenard
• ToSca International
• Nîmes, France

2
Summary

• Introduction
• Health Status of the European Union
• I General Situation
• II Healthcare Services
• Healthcare Administration
• I The French Healthcare Administration
• National Organization
• Local Organization
• Rights of Patients
•  

3

• II Social Insurance
• Social Security General System
• Complementary Insurance
• Social Aid
• III Medical Care Services
• Hospitals
• Public Hospitals
• Private Hospitals
• Beds in Hospitals
• French Hospitals Classification
• Health Professionals

4

• Medical Technology Industries Market
• I World / European Market
• II French Market
• III National Representation
• Pharmaceutical Market
• I French Market
• Analysis Laboratory Market
• I Introduction
• II Presentation
• III Evolution of the analysis Laboratory
• Sector
• VI National Representation
• Research
• I Public Sector
• II Private Sector

5
Introduction

• France is the second largest European country
  with 59.8 million inhabitants. Every French
  citizen has now access to healthcare facilities
• The French Healthcare System is considered by the
  WHO-World Health Organization the most
  efficient in the world, before the United States
  and Germany though they spend much more money
  than France does on healthcare.
• In 1990 the health care expenses represented 8.6
  in France and ten years later 9.3. In 2001, they
  increased to 9.5 of the GDP while the average of
  the OECD countries was 8.5.

6
Introduction

• According to Le Monde (French newspaper), in 2002
  health care expenses had increased to 10.4 of
  the GDP in France. That is to say 157.9 billion
  . Last year, every French citizen spent about 2
  218 on healthcare.
• The French Social Insurance reimbursed 75.5 of
  expenditure in health care and medical goods in
  2000.

7
The French Healthcare Administration

• The French State is, by definition, responsible
  for the public interest and for the health of the
  population. The government plays a major role in
  the healthcare organization through different
  ministries. It is responsible for every problem
  that can happen in the field of healthcare. In
  order to take on this function, the French
  government works with different bodies, which
  independently define priorities and needs in
  their own sphere of activity.

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The French Healthcare Administration

• 1. National Organisation
• The Parliament
• The High Committee for Public Healthcare
• The National Conference for Public
• Healthcare
• The Regional Conferences for Healthcare
• The National Agency for Accreditation and
• Evaluation in Healthcare
• The National Ethical Council

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The French Healthcare Administration

• 2. Local Organisation
• D.R.A.S.S.
• D.D.A.S.S. Regional Departemental
• Departments for Sanitary and Social Affairs
• 3. Rights of Patients
• Right of access to the medical file, amicable
  settlement of disputes, compensation for
  damages, patient becoming more aware of his
  responsibilities and associations are currently
  important issues.

10
Social Insurance

• Social Insurance against financial risks linked
  to an illness is taken on at 75.5 by the Health
  Insurance (Assurance Maladie) which is a branch
  of the Social Security (La Sécurité Sociale).
• CMU (Coverage for free of private insurance) is
  now available to lowest income.
• Social security deficit will break the record in
  2003 and 2004 (by the end of 2004 30 billions of
  Euros)
• 1. Social Security General System
• C.N.A.M.T.S
• C.R.A.M.
• C.P.A.M.
• M.S.A.
• C.A.N.A.M.

11
Social Insurance

• Other less important systems are taking charge of
  other small professional categories such as SNCF
  (French Railway Company), underground workers,
  sailors
• 2. Complementary Insurance
• 3 kinds of organisations are covering the
  complementary insurance
•     Mutual Insurance Companies, (No 6 500)
• Private Insurance Companies, (No 80)
• Provident Societies (No 20)

12
Social Insurance

• Because of the implementation of the personal,
  independent aid, the expenses of the social aid
  have increased in 2001. The item of the children
  and family aid remains the most important before
  the aid to the disabled.

13
Medical Care Services

• In 2000, 1.65 million people work in the health
  sector (7.1 of the working population)
• The Health Code regulates the professional
  practice and the functioning of the health
  establishments

14
Medical Care Services

• 1. Hospitals
• In France, Hospitals are public or private.
  They have specific tasks, organization,
  equipment, types of patients and means of
  remuneration. These specificities are determined
  by the "Planification Hospitalière" (Hospital
  Planning) which, in each region specifies
• La Carte Hospitalière (Health Map) which defines
  the needs of the different sectors for staff and
  equipment
• The S.R.O.S Regional Sanitary Organization
  Diagram (Schéma Régional d'Organisation
  Sanitaire) which organizes the distribution of
  equipment (beds, devices, heavy materials) in
  each region

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Medical Care Services

• The Board of Directors of each hospital votes for
  its budget every year
• 1-1- Public Hospitals
• Public Hospitals are only in charge of specific
  care the remaining care is provided by the
  private sector. Large hospitals are also in
  charge of research and teaching.
• In 2002, there were there were a little less
  than 1000 public hospitals (1 063 in 1997) 315
  387 beds (-15.7 compared to 374 002 beds in
  1997), and they were employing 763 350 persons.

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Medical Care Services

• 1-2- Private Hospitals
• Because of economic matters, the private sector
  has orientated its activity to very acute care
  and specific surgeries. It is composed of many
  small establishments, even if a large number of
  clinics have recently merged in order to acquire
  good and sophisticated technical equipment.

17
Medical Care Services

• 1-3- Hospitalisation Beds by Regions
• Limousin that has 1151 beds for 100 000
  residents, is far ahead of Corsica (989 beds) and
  another unexpected region, Auvergne (987 beds).
• The most populated regions are generally quite
  badly equipped by materials. If Rhône-Alpes has
  the eighth position (863 beds for 100 000
  Inhabitants), Provence-Alpes-Côte dAzur the
  seventh (779 beds), Ile-de-France antepenultimate
  (704 beds) and the Nord-Pas-de-Calais before the
  last position (684 beds).

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Medical Care Services

• 2. French Hospital Classification
• Even if French hospitals give back the figures
  of their activity to the P.M.S.I every month.
  Information System for Medical Program (Programme
  Médicalisé des Systèmes de Santé), there is no
  official classification for the management or for
  the quality or quantity of care they give.

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Medical Care Services

• 3. Health Professionals
•   Members of the health professions, medical and
  paramedical staff represent about 50 of the
  employees in the Health Sector.
• This has increased in the past 20 years and the
  French authorities are working very hard to
  stabilize it or hopefully reduce it.

20
Medical Care Services

• Even if France has never counted more on doctors
  in terms of the healthcare, the country suffers
  from medical poverty, concerning both the general
  doctors and the specialists. In addition, their
  presence in the regions is largely unequal.
• Between 2000 and 2001, the total number of
  doctors has increased in 9,3 in each region.
• Currently France is about to raise the price of
  consultation at a special doctor to 25
• Generics are compulsory in doctors prescriptions

21
Medical Technology Market

• I World / European Market
•  
•  

22
Medical Technology Market
23
Medical Technology Market

• II French Market
• 20 000 people are employed in this sector, and
  25 of them work for the export business  
• The price of this equipment can vary from 20
  centimes 3 million

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Medical Technology Market

• III National Representation
• The SNITEM - National Union for Medical
  Technology Industries is a professional
  organization bringing together manufacturers from
  the medical technology field
• www.snitem.fr

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Pharmaceutical Market

• I The French Market
• The French market for pharmaceuticals grew by
  4.2 in 2002 to reach a value of 18.3 billion
• In France, about 4 million customers go to the
  chemists' every day
• Each French citizen spends 381 on medicine
  every year
• Each medicine must obtain a A.M.M. (Sales
  authorization) and its price is fixed through
  discussions between firms and the social security
  representatives, then, this price is confirmed by
  the French Ministry of Social Affairs

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Pharmaceutical Market

• This price is composed of
• Manufacturer 64.4
• Pharmacist 24.6
• Wholesaler 3.4
• State 6.2

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Pharmaceutical Market

• The French Pharmaceutical Sector in 2001
• 302 firms (310 in 1999)
• The first 10 make 40 of the global turnover, the
  first 50, 80
• France is the first European producer before
  Germany, Great Britain and Italy
• 3rd Exporting country
• Turnover 27 billion
• 9.6 billion go towards export
• The pharmaceutical industry finances its research
  at 99, therefore, it spends 12.5 of its
  turnover to finance it

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Pharmaceutical Market

• Medical information and advertising is also
  covered by the pharmaceutical industry which also
  spends 12.2 of its turnover for it
• The sector employs about 200 000 people
• 118 000 in chemist's shop
• 90 000 in production firms
• 15 000 in wholesalers

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Pharmaceutical Market

• French Independent Laboratories
• After a few years of regular decrease, the share
  of the market of the pharmaceutical laboratories
  with French capital was steady in 1999 at 39 of
  the pharmaceutical market in France.
• If the groups Aventis and Sanofi-Synthélabo
  reinforce their positions slightly, the
  private-funded independent laboratories are
  declining, decreasing from an estimated share of
  the market of 21 in 1997 to less than 18 in
  1999.

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Pharmaceutical Market

• Renewal of products portfolio more than 50 of
  sales realised by the FILs were generated by
  commercialised specialities before 1980. More
  worrying the majority of products launched since
  1990 have had a modest turnover, with annual
  sales not above 21 M .
• The necessary development of the activity beyond
  our frontiers, growth relay facing the
  difficulties on the national market. On the
  whole, the FILs are characterised by a low degree
  of internationalisation and well-below the
  average of the French pharmaceutical sector.
  Approximately 15 of them have a significant place
  abroad.

32
Analysis Laboratories Market

• I Introduction
• Biological medical analysis are medical tests
  that are helping to define a diagnostic, a
  treatment or to prevent human diseases. It can
  also help to discover other changes in the
  physiological state. Born in the 50's, this
  discipline is still technically progressing
• Every day about 200 000 patients go to an
  analysis laboratory to confirm, or infirm a
  diagnostic, to prevent the development of a
  disease, to begin a treatment or to be detected

33
Analysis Laboratories Market

• Each year, a French person spends 49.7 in
  medical analysis
• Analysis expenses represent 2.6 of the total
  health expenses
• II Presentation
• There are 5 321 analysis laboratories en France
  (943 of them work in clinics or hospitals)
• The sector employs 35 000 people 7 000
  biologists (85 pharmacists, 15 doctors)
• The annual turnover is 2.6 billion and the
  Social Security finances 2 billion

34
Analysis Laboratories Market

• Medical Biology is made up of 4 big branded
  products
• Microbiology micro-organism study (bacteria,
  virus)
• Haemathology blood study its composition, its
  compatibility with other bloods and its diseases
• Immunology immunitary reaction, infectious
  diseases, and allergy
• Biochemistry molecule study (glycaema,
  cholesterol)

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Analysis Laboratories Market

• III Evolution of the Analysis Laboratory Market
• Medical Analysis Laboratories are very important
  in the French healthcare. It is said that today,
  80 of the diagnostics are defined after a
  medical analysis
• The Biologist's job is changing from technical
  biology in the last few years, it has become a
  clinical biology to be more efficient in
• Molecular Biology
• Sanitary Surveillance
• Screening and prevention
• This evolution is necessary to find solutions to
  the ageing of the population and to new
  pathologies such as HIV and Hepatitis C

36
Analysis Laboratories Market

• New technologies, automation, data-processing and
  miniaturization are transforming the activity of
  the profession. Tomorrow, machines will carry
  out analysis and interpretations and it will be
  more secure.

37
Research

• Research in France can be private or public and
  the State finances 41.8 of the total research
  expenses
• I Public Sector
• Composed of different organisations
• I.N.S.E.R.M Medical Research Health National
  Institute
• C.N.R.S Scientific Research National Centre
• I.N.V.S Sanitary Surveillance Institute
• A.F.S.S.A.P.S National Agency for Health
  Product Sanitary Security

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Research

• C.E.A Atomic Energy Comity
• O.C.P.R.I National Centre for the
• Protection against Ionising
  Radiations
• C.H.U University Hospitals
• II Private Sector
• Principally composed of
• The Pasteur Institute,
• The Curie Institute,
• Pharmaceutical Laboratories, which finance
• their research expenses at 99

39
Conclusion

• The French healthcare is under pressure with the
  social security deficit of the state
• Hospitals are giving in 2007 new hope to renew
  infrastructure, mainly administration efficiency
  and emergency

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Conclusion Services

• The French are consuming more and more on health
  services
• The French population is ageing so that a lot of
  new services are required in home care,
  laboratories, pension house equipment
• The French healthcare is in constant growth with
  private insurance facilities
• Direct service to people and homecare is under
  serious discussion specially for elderly ones.
• Labs need to offer more competitive medicines in
  terms of price and efficiency.