Interview with Lamine Gharbi, President of the French Federation of Private Hospitals (FHP)
Hospital tariffs for the public and private sectors have been published for 2025. Can the two sectors be considered to be on an equal footing?
Last year, the discrimination in tariffs (+4.4% increase for the public health sector versus +0.4% increase for the private sector) was obvious and fully accepted by the government. It led the profession to launch a massive mobilisation movement in the spring of 2024. The 2025 campaign is more subtle: behind the façade of fairness, the 0.5 point increase in hospital tariffs for the public and private sectors in a context of inflation does not cover changes in costs and is detrimental to the fulfilment of missions. For example, the so-called ‘Borne’ social measures for night and weekend duty were supposed to be paid in addition to hospital charges, but this has not been the case.
One billion euros of inflation has not been compensated for over the last three years. In the private sector, 45% of establishments will be in deficit in 2025, compared with 29% in 2022, as our annual economic study shows.
Beyond this, the major factor of differentiation and discrimination lies in social policy and the upgrading of professionals: as they fulfil the same missions, it is neither understandable nor acceptable that healthcare professionals in the private sector do not benefit from the same recognition as those in the public sector. The inadequate funding of our social agreement (known as ‘Avenant 33’) bears witness to this, and this issue remains one of the major demands of the FHP.
What are the main issues and demands of the private health sector in this situation?
The first demand is very clear: to be able to implement the wage agreement expected by the 170,000 professionals in our sector, thanks to adequate funding. At present, they are not up to the task. We are asking the government to do something to support the proactive social, pay and attractiveness policy that our industry has always been keen to pursue.
We are also hoping for the imminent signing of a new multi-annual resources protocol for healthcare establishments, between the State and the hospital federations. We have waited too long for this, not least because of the political instability in France in recent months, but our Health Minister seems to have a strong desire to bring this matter to a successful conclusion.
Finally, we have formulated very clear demands and proposals for simplifying the healthcare system, and for fully involving the private sector in policies for continuity and permanence of care. We refuse to be seen as stand-ins, because we play a major role in the provision of healthcare, accounting for 35% of activity while ‘consuming’ only 17% of health insurance resources.
To what extent might European rules on regulated prices be important in ensuring that, in each country, relations between governments and private providers are more transparent, equitable and predictable?
The key is the multiannual vision of funding that must permeate all healthcare systems. It is no longer possible for decisions to be reshuffled every year, especially at a time when we absolutely must be at the forefront of innovation for patients. Collective maturity must enable us to move from injunctions and arbitration to real contractual arrangements between the government and healthcare players, based on transparency and fairness.
In France, FHP is strongly in favour of the emergence of a genuine Public Health Service, which would disregard statutes and unite all players around public service missions. This would be a major paradigm shift to encourage genuine cooperation at local level, in response to the needs of the population. Against a backdrop of severe financial pressure, the answer lies in the effective mobilisation of all resources, regardless of status. This quest for unity requires recognition of the Public Health Service.
A few figures
The Fédération de l’Hospitalisation Privée represents France’s 1,030 private hospitals and clinics, which treat 9 million people every year, including nearly 3 million in 122 emergency departments.
We account for 35% of hospital activity, and 17% of health insurance funding.
170,000 employees work in private health establishments and 40,000 self-employed doctors work in them.
55 million French people live less than 30 minutes from a private healthcare establishment.
20% of people receiving complementary health insurance or State Medical Aid are cared for in a private health establishment.
Private clinics and hospitals provide 56% of surgery, 65% of outpatient surgery, 42% of medical and rehabilitation care, 22% of psychiatric hospitalisation, 20% of home hospitalisation, 38% of care for cancer patients and 36% of care for patients with chronic kidney disease. They are responsible for 16% of births.
