NHCC in Paris: Rebalancing a system at risk

Published April 11, 2013 by Aileen Katcher

Editor’s note: This is the fourth in a series of posts this week from the Nashville Health Care Council’s International Health Care Mission to Paris. To view others, click here.

Nashville Health Care Council members on the International Mission in Paris started their day with a discussion about their impressions of the French health care system based on the first three days of meetings, presentations and hospital visits.  Among the comments:

• We heard a lot about the need to control costs, but no clear plan.

• There have been many good things we could learn from the French.  But their operational processes are not similar to those in the U.S.

• French patients receive all their health care information from the government and providers, not from advertising or the media as in the U.S., so there is no level of consumerism.

• What will change the system here? Will those who can pay for care drive it?

• The French have a centralized system but still struggle with many of the same issues we do in the states.

• There is a hierarchical structure that makes it difficult to report problems with physicians.

• There is no motivation to commit fraud when there is no profit in it.

The rest of the day’s activities included a panel with French private health care CEOs, a briefing on the public – private partnership between France and Nashville-based company Healthways and discussions about hospital performance, utilization of ehealth and health care financing trends in the EU.

Much of what the CEO panel told us confirmed what we heard earlier in the week.  The current system was created in a time when it was believed that health care is priceless, but in today’s world it does have a cost and the government which controls it has less and less money.

There is growth in demand, but it is difficult for the private hospitals to get approval to provide services to meet those demands as the government tends to favor public hospitals with those approvals.  Sensitivities for the private providers are physician fees, drug costs and reimbursement. On the positive side, outpatient services are profitable and growing and private providers are shifting toward them.

The session closed with a panelist saying “we must rebalance a system that is at risk.”

To that end, the next session highlighted Sophia, a partnership between the public insurance system in France and Nashville’s Healthways.   It is based on the recognition that the French public insurance system needs re-structuring for more cost efficiency and to move from being a payer to being an active risk manager that encourages citizens to participate in their own well- being.

The pilot program, launched in 2008, was focused on diabetes and has seen improvement in diet and exercise and treatment compliance among participants.  The team will tackle asthma and cardiovascular disease beginning this fall.

The discussion about performance reminded us again of the cultural and philosophical differences between France and the United States. Performance measurement is a new concept here and one that is not popular. The country has always spent a lot of money on health care but never asked for accountability from providers or patients. Now they are asking for accountability from both and for providers to focus on operational efficiencies.

The government formed Performance National Agency of Health Care and Medico-social Institutions (ANAP) to assist in improving performance.  It is working hand-in-hand with providers and the regional health authorities on a hospital-by-hospital basis so that each can learn from the other’s best practices.  The effort is just a few years old, and while improvements have been made, leaders feel there is still room to improve.

The ehealth arena is another area that needs improvement. The director of ASIP, France’s public agency of shared information system for health, cited the need for the right balance between regionalization and centralization as well as defining the role of public versus private involvement.

As in the U.S., privacy concerns also present ehealth challenges.  We learned earlier in the week that the supplemental insurance companies are not allowed to keep data about members, either individually or aggregated. Using information technology to streamline the system is a long term goal.

To end today’s program, we heard from a panel of health care finance experts.  Moderated by a partner from Deloitte & Touche, panelists were from J.P. Morgan, Rothschild, 3i and Nixen Partners.

We learned that IPO activity here is low; equity markets are volatile but trending towards less volatility; health care stocks are rising, but not as much as the U.S.; when it comes to debt, the bank market is very tight but high yield markets are reasonably robust and health care merger and acquisition activity is in decline.

Institutional lending is growing in France and there have been significant institutional deals in health care. The experts said some U.S. investors are looking to Europe and France in particular, but those who are should seek fresh ideas with determination and patience.