What is the current situation in the follow-up and rehabilitation care sector in France?
The follow-up care and rehabilitation sector in France is in the midst of a reorganisation phase, with a reform of authorisations that has just been completed and a reform of the financing mechanisms that are underway (reform of classification, reform of pricing and reform of the co-payment).
The reform of authorisations, jointly developed with the Ministry of Health, is positive for our sector of activity. The “follow-up and rehabilitation care” sector is now called “medical and rehabilitation care”. This is a necessary adjustment with regard to the medical care offered.
It now recognises, alongside specialised medical and rehabilitation care establishments (cardiovascular, pneumology, neurology, musculoskeletal, etc.), multi-purpose establishments, which becomes a separate category, as do paediatrics and cancerology. Medical and rehabilitation care establishments will automatically have authorisation for full-time hospitalisation and part-time hospitalisation
What is the status of the tariff reform?
The tariff reform, which is due to come into force on 1 January 2023, is much more problematic because it affects the very basis of the private sector’s operating mode: activity-based remuneration.
With the new reform, private establishments – all of which are affiliated to the social security system and subject to authorisation – will no longer be paid 100% on an activity basis, but only 50%. The remaining 50% will be a mix between a population-based allocation (40%) and several other compartments (technical platforms, expertise activities, financing of expensive molecules, quality-based financing, etc.). If the model applies to all medical and rehabilitation care hospitals (public, private, private non-profit), private hospitals note that the major losers of this reform are the specialised establishments, based on partial simulations transmitted by the Ministry. In addition, depending on the legal status of the establishments, there is a different weighting scale as well as a pricing scale that shows a difference of 20% to more than 100% in favour of the public sector for the same care, with the same types of patients, creating an inequity of treatment and unfair competition between the sectors.
While private hospitals stand out for their dynamism, excellence in care, specialisation and capacity to offer modern technical facilities, it is feared that they will stop investing, refocus on care for less serious patients, and restrict their capacities, resulting in a lack of agility for the establishments and long waiting lines for patients.
You have just returned from a study trip to Italy where a French delegation visited medical and rehabilitation establishments. What lessons did you learn?
This study journey was very instructive and taught us that no system is perfect. It is very important to be able to benchmark oneself, especially when it comes to making trade-offs at national level, as is the case in France at the moment.
In Italy, the public and private sectors receive the same tariffs, which we can envy them. However, they are subjected to patient quotas which can be problematic, especially at the end of the year, once they are exhausted.
The Italian private medical and rehabilitation care hospitals are allowed to have purely private beds in addition to their permanent activity, with tariffs that they set freely. This is a way of allowing people who can afford it to be treated quickly and to benefit from improved care, but it does not solve the problem of access to care and waiting lists for other patients.
From the point of view of technical facilities, we visited some extremely modern establishments and others that are less so. The gap between the best and the worst is perhaps wider than in France, but what unites us is that the Italians have the same human resources problems as we do in France.
In the past, we visited establishments in Sweden and Denmark and we were interested in structures managed mainly by municipalities, where care is provided solely by paramedics, with patients only seeing a doctor if necessary.
The French private medical and rehabilitation care facilities in figures
- 480 private private medical and rehabilitation facilities
- 40,000 beds and places
- 13,600,000 days of hospitalisation
- 36% of total days at national level (all hospitals) and 42% of part-time activity