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Presentation of the Principles of the New Health Bill

Hélène Bernhard

20 June 2014

Marisol Touraine, French Minister for Health, has presented on Thursday (19 June 2014), during a press conference, the main measures of the proposed new Health bill. The text should be submitted to the French Council of Ministers in September 2014 and should only be examined by the French Parliament (Assemblée Nationale) at the beginning of 2015. The bill is composed of the four key strategic principles described below.

1. MAKE PREVENTION ONE OF THE FOUNDATIONS OF THE FRENCH HEALTH POLICY

"The responsibility of the State, in the field of health, begins with prevention".

  • The bill "does not contain […] any tax measures"
  • The bill will contain commitments presented as measures towards the younger generation, in particular:

    • creation of an "educational health course" integrated to school programmes;
    • creation of a tool in order to help people understand the information concerning the nutritional quality of industrial food. The issue of the practical implementation of such a tool is currently under examination;
    • regarding sexuality, free access for young women, without any conditions, to emergency contraception by deleting the criterion of "clear and established distress".

  • The bill will contain commitments towards isolated populations, in particular:

    • further work on the risk reduction policy concerning AIDS, especially in prisons;
    • define a framework for the experimentation of drug consumption rooms (salles de consommation à moindre risque);
    • generalisation of Rapid Screening Tests (Tests Rapides d'Orientation Diagnostique) to facilitate access to screening.

  • The Minister has also presented the means that will be used to implement this policy:

    • creation, on 19 June 2014, of a French inter-ministerial health committee for the purpose of a transversal treatment of health topics;
    • strengthening of the effectiveness of administrative structures with the creation of a French public health prevention, monitoring and intervention Institute.

2. IMPLEMENT A TERRITORIAL HEALTH SERVICE FOR THE PUBLIC TO IMPROVE MEDICAL CARE

"[…] The French People do not all have the same chances of being cared for in good conditions."

The purpose of the territorial health service for the public will be to improve access to healthcare for all and will organise a process based on a "first efficient resort" as well as on a "renovated hospital service" and will concern five key sectors (proximity healthcare, continuity of care, prevention, mental health, access to healthcare for the disabled). The role of regional health agencies (ARS) will be strengthened in order to support this approach.

  • The bill contains measures to strengthen access to healthcare for all, in particular:

    • generalisation of the third-party payment system for the share corresponding to health insurance and the one corresponding to private insurance. Beneficiaries of the private insurance assistance services (ACS) will be exempted as early as next year from the obligation to advance costs. The third-party payment system will then be extended to all insured people by 2017. A technical committee is currently in charge of the implementation of this reform; 
    • guarantee of affordable prices for health products, such as glasses (however, no concrete measure has yet been announced); 
    • strengthening of the measures against denial of healthcare;
    • creation of a unique three-digit telephone number in each department for duty care in towns in order to guarantee the continuity of care; 
    • creation of a "health GPS" and of a public health information service with an Internet portal and telephone access, implemented in each region by each ARS;
    • provisions concerning support systems, in particular associations, for some patients.

  • The bill contains measures to implement an organised process, in particular:

    • delivery of a "liaison letter" (lettre de liaison) to each patient leaving hospital, for coordination purposes with city doctors;
    • creation by city doctors of a customised healthcare programme for chronic patients;
    • creation by the ARS of territorial support platforms for health professionals in order to ensure the best quality of care for the most complex patients;
    • reform of the shared medical record, the implementation of which will be entrusted to the public health insurance system by integrating the issues concerning secured messaging services; 
    • gradual and negotiated evolution of the health professional and institution remuneration mechanisms. For this purpose, negotiations have started between the public health insurance system and private practitioners in order to implement team remunerations. Should the negotiations be unsuccessful, the Minister will proceed by an arbitral regulation.

  • The bill contains measures to update the public hospital service, in particular:

    • measures guaranteeing permanent access and admittance within reasonable time periods taking into account the condition of the patient and equality of access to healthcare;
    • clarifications concerning the conditions to practice privately in hospitals and concerning temporary medical work (ceiling on the remuneration for the latter category);
    • mandatory creation of territorial hospital groups in order to share certain functions such as IT systems, initial training or main functions such as the purchases. Each institution will defend a common medical project for each territory;
    • rebalancing concerning hospital governance.

3. WAGER ON INNOVATION

"The health of the economy also goes through the economy of health!"

  • The bill proposes the generalisation of the single agreement system (convention unique) to all categories of health institutions.
  • The bill recognises new health professions.
  • The bill addresses issues relating to open data, based on the work of the open data commission. 

4. ESTABLISH NEW GOVERNANCE FOR A MORE EFFECTIVE HEALTH POLICY

"There is only one health policy and everyone must contribute for its share, national as well as local stakeholders, public as well as private stakeholders".

  • The bill will provide the means to achieve better coordination between the State's and the health insurance system's actions
  • The bill aims at supporting social dialogue, with the setting up of a French higher council of hospital medical staff.
  • The future law will allow patients to "co-build more health policies", especially by extending the obligation of representation of the health system users in the ARS and by setting up the health system users' commission.
  • The Minister has also underlined that the public health debate will be reinforced by the creation of a Patient Institute, which is currently entrusted to the French Public Health School.
  • The bill also contains provisions to allow access to the medical record of a deceased person by his/her partner or civil partner (PACS).
  • Lastly, the Minister concluded her speech by mentioning that class actions would soon be introduced. In this respect, the Minister indicated that "to reach maturity in the field of health democracy, it is also necessary to strengthen the power given to patients when they are victims of damages. In light of the serial damages in the health sector, a law right could be contemplated: the introduction of class actions. This would represent major progress. Compensations would certainly be determined on a case-by-case basis but our fellow citizens would no longer be alone against the power of some industries". The Minister did not mention any concrete measures.

We will continue to monitor this topic. Please do not hesitate to contact us should you have any questions on these issues.

Hélène Bernhard

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