|Hospital and medical equipment planning|
|Implemented in this survey?|
The major parameters of organisation and planning of healthcare facilities have been modified substantially by redefining the role of regional strategic health plans (SROS - Schéma régional d'organisation sanitaire). The new plans put greater emphasis on the health care needs of the population at the local level and promote an integrated health care approach coordinating prevention, acute and rehabilitation care.
With the ordinance of September 2003, the strategic regional health plans (SROS in French) became the main tool of planning and distributing hospital resources in France. The reform aims to simplify hospital planning by merging several planning tools and to reinforce the role of regional hospital agencies in controlling local hospital activities.
The new SROS (SROS3) have been implemented since the beginning of 2006 and brought some major structural changes in health care planning
Overall, the "medical plan" for a health territory structures all individual hospital plans/contracts in that territory. Objectives and resources demanded have to be coherent.
More generally, this new generation of health plans requires a more integrated approach to health care planning. Regional hospital agencies are not only responsible for organising the acute care supply but also prevention, rehabilitative and long-term care. Coordination between ambulatory services, social services and hospital care is required.
Ministry of Health, regional hospital agencies (ARHs), hospitals, elected representatives and users of health care.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Hospital planning in France has been very centralised and rigid since 1970. Both public and private hospitals required to have authorisation to increase their bed numbers or to buy heavy medical equipment. The authorisations were regulated by the "medical map" (carte sanitaire), which set out target capacities by geographical area.
Deconcentration of hospital sector planning to better satisfy regional health needs has been part of the major hospital reform plan "Hospital 2007" (HPM survey (9)2007).
Until 2006, hospital planning has been carried out for 5 yearly periods with two legal instruments: hospital map (sanitary chart) and regional strategic health plans (SROS).
|Implemented in this survey?|
The approach of the idea is described as:
The idea seems to be well-accepted by most stakeholders. The elected representatives and hospital federations recognize that the new "health territory" approach can improve the organization frame, especially by increasing the dialogue between different actors.
|Ministry of Health||very supportive||strongly opposed|
|Regional hospital agencies||very supportive||strongly opposed|
|hospitals||very supportive||strongly opposed|
|health professionals||very supportive||strongly opposed|
|patients||very supportive||strongly opposed|
|Ministry of Health||very strong||none|
|Regional hospital agencies||very strong||none|
|health professionals||very strong||none|
The definition of SROS was preceded by a national consultation process on general directions. This preliminary work is organized around a think tank which brought together medical professions, the Ministry of Health, hospital federations, regional hospital agencies, national and regional unions of the insurance funds, local/regional planning department and independent experts.
The Regional Hospital Agencies have the main responsibility for preparing the SROS for the period of 2006-2011. The preparation involved meetings and collaboration between health professionals, hospitals federations, ambulatory actors, elected representatives and users over a period of two years.
At the end of March 2006, the SROSs were adopted. They define for each health territory a medical project which describes precisely the actions to be carried out over the next five years to reach a set of specific local objectives.
Contracts defining specific health service objectives were signed between hospitals and regional hospital agencies in March 2007.
The ordinance of September 2003 and the public health law voted on in August 2004 imply that there should be an evaluation of the SROS, but no specific procedure for evaluation is suggested.
Some regions like Rhône-Alpes have already started an evaluation process based on objectives defined in the SROS. For the moment, they are working on data collection for evaluating SROS and the agreements made with hospitals.
Hospital management becoming more regional (less central) should improve the satisfaction at the local level.
Nevertheless, the hospital payment reform (called T2A) which introduced a new case mix-based prospective payment system (see the HPM report (5)2005) might create conflicting pressures. For example, T2A encourages hospitals to increase their acute care activity while quantitative objectives fixed by the regional hospital agencies (ARHs) try to limit it. Some observers think that the hospital payment reform will have a bigger impact on the restructuring of hospital supply than SROS.
Moreover, while SROS brings a new approach to the regulation of inpatient care facilities, currently there is no real territorial organisation of outpatient care. The freedom of installation is firmly defended by liberal physicians, despite the very unequal territorial distribution of medical care. [The National health Conference demanded recently to restrain extra-billing to patients to improve the equity in access. There are some propositions for restricting physicians' freedom of installation (with negative financial sanctions) in the 2008 project for financing social security, but this received strong opposition from physicians and medical students]. The idea of creating new regional health agencies, with enlarged mission of controlling inpatient care, outpatient care and public health plans, was in the presidential programme of Nicolas Sarkozy. Their possible creation could completely change the healthcare organisation landscape.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Establishment of strategic regional plans (SROSs). Ordinance of 4th September 2003, available at www.legifrance.gouv.fr
Ministry of Health. Territoires et accès aux soins. (Preliminary publication on the definition of health territories). Paris, 2003. Available at www.sante.gouv.fr/htm/publication/dhos/sros/sommaire.htm
Ministry of Health. Plan Hôpital 2007. www.sante.gouv.fr/htm/dossiers/hopital2007
Safon, Marie-Odilde. L'hôpital en France: 1995-2005. (Hospital in France: 1995-2005. A bibliography). Documentation de l'IRDES, December 2006. Available at www.irdes.fr/EspaceDoc/DossiersBiblios/HopitalFrance.pdf
|Hospital and medical equipment planning|
Process Stages: Implementation
Véronique, Lucas-Gabrielli and Coldefy Magali