January 2021 – Frédérique Gama, newly elected president of the French Federation of Private Acute Care Hospitals (FHP-MCO) and Director of the Charcot Clinic near Lyon
What is the fundamental role of the National Union of Private Health Establishments in Medicine, Surgery, Obstetrics, of which you have assumed the presidency?
To defend each private healthcare establishment, to collectively defend our standing in the French healthcare arena, and to capitalize on this new positioning. Next, our great challenge is to simplify the administrative context in which we work. Our Ministry has a visceral need to create laws and regulations, whose actors on the ground understand neither the stakes nor the interest. The administration is self-feeding in a closed circuit. A misunderstanding shared by the public hospital as well. Our strength is our responsiveness but managing the very complex administrative environment imposed on us requires a huge amount of energy that does not benefit the patient.
The French hospital system rests on three pillars, a public, private non-profit and private sector that takes care of approximately 30% of patients. What are the strengths of this “French ” system?
The first strength is that no sector has a monopoly, which anyway is never an advantage for the consumer. When a company has a monopoly on a service or a product, why would it be worried about winning the market? Having a relatively strong private hospital sector facing public hospitals, which are by definition strong, is an opportunity for the patient. Allowing them to choose their health care institution creates de facto a healthy competition between the players.
However, our weakness with regard to the patient is the excess cost (even if it is a modest sum), which after reimbursement from the National Health Insurance and complementary insurances, remains to be paid by the patient at the end of his stay – except for emergency care, which is totally free of charge for all. Therefore, we have the obligation to offer exemplary care to the users who trust us and give them an above-average service. All private hospitals are under agreement with the National Health Insurance and the State (except the American Hospital in Paris). The rates charged are set by the State, and we are only allowed to set our own prices for extra services (private room, catering, etc.). The doctors who practice in our clinics have a liberal status and are hospital employees only in very rare cases. Their rates are also set by the State, but a large part of the practitioners are free to charge additional fees.
For the State, having private hospital facilities that are less expensive to the National Health Insurance is an advantage, as the latter would be unable to assume the additional cost of financing care if it were carried out exclusively in public hospitals, at public hospital prices. Although the regulations, training, etc. are strictly identical, the 20% extra cost of the public hospital sector remains unexplained.
During the crisis, the French hospital system demonstrated its resilience, but the public hospital sector also demonstrated that it could not have faced the epidemic alone. Our private sector showed its extreme responsiveness everywhere in France. We adapted in 24 hours to meet the needs of Covid patients such as those in intensive care, or lately this month for vaccination. The proof of this is that the Minister of Health has acceded to our requests for additional funding for the care of Covid patients and has included us in the revaluation of the salaries of our professionals within the framework of the Ségur de la santé agreement (new social security law adopted last summer). In my opinion, and with the current crisis, this is the first time that the place of private hospitals has been recognized to such an extent. Likewise, the population saw that we could achieve important things…as well as the regional health agencies (regional branch offices of the Ministry of Health)!