Public and private operators in France have big questions over a controversial new healthcare reform bill. Healthcare Europa journalist Ariane Jugieux speaks to Stéphane Pichon, managing partner at Your Care Consult, about the repercussions the bill may have on the future of healthcare in France.
Three of the biggest physicians trade unions, later joined by specialists, are asking doctors not to work between December 24 and December 31. The Fédération de l’Hôspitalisation Privée (FHP), which represents over 1,000 private operators in France, has called for an indefinite cessation of activity from January 5, 2015.
Pichon is not as pessimistic as most operators Healthcare Europa spoke to about the bill. “There are three themes to this bill: prevention, ease of access, and structural reorganisation of healthcare”, says Pichon. “The first two elements are actually positive for healthcare in France”.
However, parts of the new bill anger the public sector as much as the private one, according to Pichon.“Doctors and hospitals will see a decrease in patient numbers as midwives and chemists will be able to vaccinate. It opens the market to non-doctors, meaning physicians will lose their monopoly on certain procedures”.
Pichon believes such measures are necessary to combat against ‘medical desertification’ in France. “There are just not enough doctors in less populated areas. Some routine procedures, such as vaccinations, need to be devolved to a greater variety of professionals. Revenues might suffer, but that is not necessarily a bad thing for patients”.
Public and private sector workers are united against specific projects, such as reforms on association. Pichon fears the introduction of US-style ‘class-actions’, where victims of gross misconducts will be allowed to form associations to sue doctors and practices to get reparations.
While Pichon recognises the bill have an impact on private operators, he still believes in its “ideological dimension”. “The government is committed to curbing the private sector”, he adds. Hollande’s government suffers from the lowest approval rating of any presidency since 1958, with only 13% in August 2014.
Private operators are specifically targeted in provisions aiming to reform the 2009 ‘Hôpital, patients, santé et territoire’ law (HPST), introduced by the Sarkozy administration to make public hospitals more efficient, says Pichon.
The HPST law, which translates as ‘Hospital, Patients, Health, and Territories’, was put in place to modernise public hospitals and increase their efficiency. Managers were brought in to curb spending, but mayors still stand as presidents of public hospitals.
The HPST law allowed public hospitals to be organised around 14 different missions that had the authority to cooperate with private clinics. The new bill means public hospitals will no longer be divided into 14 independent administrative blocs. Instead, just one authority within hospitals will decide on partnerships for all services. “This is to encourage further agreements between public hospitals rather than public-private cooperation”.
Despite the uproar the bill caused within the FHP, Pichon is remains confident the French market has an optimistic future. “France remains a stable country for both public and private healthcare, and 2014 was a particularly good year for investment operations”.