Overview of the French public hospital sector by Pascal Garel, International Affairs, Federation of French Hospitals (Federation Hospitaliere de France), for mHealth Israel, April 2, 2020.

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FRENCH PUBLIC
HOSPITALS

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French Hospital Federation (FHF)
4 800 institutions (1 000 hospitals and 3 800
social care institutions)
more than 1 million employees
18 regional federations + Paris Public Hospitals Group
Three missions
Promote
Protect
Unite

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Key perceptions on the French public
hospitals and the healthcare system (IPSOS,
2019)
85% of French people are
satisfied with public hospitals…
But 90% of them believe that
public hospitals are in
danger…
70% of French people
believe that their system is
too complicated and hard to
understand

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French hospitals among the best for acute care
Source : State of health in the EU, 2017
Low amenable mortality due to health care, Low fatality rates for acute conditions

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Hospitals, public and private
 Hospital care : 2856 institutions (1 institution per 20 000 inhabitants)
 Publics hospitals : 1042 institutions (31% but 65% of beds)
 Private for-profit hospitals : 1442 institutions (34 % but 20% of beds)
 Private non-for-profit hospitals : 1446 institutions (35 % but 14% of beds)
Number of beds/1000 habitants (OECD 2017)

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Public hospitals
1042 institutions and 293 000 beds
34 Teaching and Research hospitals (CHU)
Public service duties : equality, neutrality, universality
Employees of public institutions, including physicians and managers,
are civil servants
1,2 millions, including around 100 000 physicians

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Public/private mix
Public, private non-for-profit, Private for-profit hospitals
Same source of funding
Co-operation between public and private hospital sectors
The planning scheme (Schéma Régional d’Organisation Sanitaire) takes
into account the size and the quality of existing facilities, the demographic
trends and progress in the field of medical technology defines

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Grouping public hospitals : 2016 law
• A Law of 2016 asked public hospitals to
gather into « Territorial Hospital
Groups » (GHT)
• There are 135 GHTs in France,
including 13 GHTs specialized in
mental health
• Generally, a GHT will regroup 1 large
hospital and several smaller sites,
including public retirement homes,
long-term care facilities, etc.
• 1 « leading hospital » (établissement
support) by GHT, but hospitals ARE
NOT merged
• Private hospitals ARE NOT members
of GHTs, but can be associated to them

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 Ensuring equal access to safe, high-quality and efficient care for ALL patients of
the territory hospital group.
 Sharing & pooling some functions to improve quality and to allow development of
the cooperation between public hospitals and also ALL health providers.
Benefits of the GHT

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An example : the GHT d’Armor (Brittany)
4 600 beds
7 000 employees
• Covers the « Côtes d’Armor »
département: 600 000 inhabitants
• Has to design and implement a
« shared medical project » (PMP)
• Human Resources remain in the
hands of each hospital
• Some support functions are merged
(IT, procurement, etc)
50 medical specialties
St-Brieuc General Hospital (non academic) is the
leading hospital

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PURCHASING
 Public hospitals purchasing: 24,7 Billion € (including 23 for
functioning and 1,7 in investment) compared to:
o 20 billion expenses for the states (outside defence),
o 10 billion for independant public institutions,
o 45 billion for local authorities.
 Important increase, increased by 52 % in ten years
 Human resources expenses: 40 billion
 Pharmaceuticals: 35,3%
 Medical devices: 12,3%
 IT: 1,7% (?)…

12. « Ma santé 2022 » reform :
the digitalization components

13. 1. Strengthen the governance
• Central Ministerial unit linked to Ministry
(délégation ministérielle du numérique en santé)
:
– Piloting all digital change,
– Closer piloting of the Health Digitalization Agency,
with a mission centralised on the operational
implementation of the digitalization policy.
• Creation of an advisory board and a ethic unit

14. 2. Interoperability and security
• Identification and authentification of
professionals through a card
• Identification of patients through the health
insurance card
• Opposability by law of interoperability
referentials
• Declaration of security incidents through a
national service of health cybersecurity

15. 3. Core Services
and
4. Health Plateforms
• Core Services : Shared
Medical File, Secured
Health Exchange of
Information, e-
prescription, digitalization
of local services for the
coordinations of patients
pathways (led by Regional
Health Agency)
• Platforms : Digital Space
for Citizens, Health Data
Hub

16. 5. Innovation and engagement of stakeholders
• Telemedicine – Telecare (high increase with
COVID-19)
• Certification of hospital information systems
• Lab e-Santé (identify, help emerging and spread
new technological concepts, solutions and help
the actors in the marked to find their way)

17. IT procurement/purchasing
• Individual hospital purchasing through public
procurement (for Digitalization the leader of
GHT are in charge, GHTs do not have legal
power)
• Group purchasing:
– Regional « GRADeS » under the authority of the regional health
agency
– RESAH : chosen by the Ministry of Health to be in charge of the
market of plateforms for e-patient-pathways
– UniHa and its group purchasing platform for hospital
digitalization (CAIH)
– UGAP (national public group purchasing organization)

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TO MEET US join our annual event (7-9 October 2020)
35 000 visitors
Pour toute information : www.santexpo.com

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Let’s keep in touch! p.garel@fhf.fr