V Miedzynarodowa V Miedzynarodowa KonferencjaKonferencja

««  Managing in Times of Managing in Times of Crisis »Crisis »

The current changes to the health system in The current changes to the health system in FranceFrance

How hospital managers have respondedHow hospital managers have responded

Bertrand BAILLEULBertrand BAILLEULCEO Hôpital Saint Jean (Paris) CEO Hôpital Saint Jean (Paris)

President European Health Managers ForumPresident European Health Managers ForumOSTRODA 30/05/2012OSTRODA 30/05/2012

The health system in The health system in FranceFrance

Some figures about France :Some figures about France : - Population : 65 Millions (70% urban/23% rural)- Population : 65 Millions (70% urban/23% rural) - 5th economical country in the world - 5th economical country in the world - GNP : 2 000 Billions Euros- GNP : 2 000 Billions Euros - National budget : 280 Billions Euros- National budget : 280 Billions Euros - Public debt : 1 700 Billions Euros - Public debt : 1 700 Billions Euros - 10% of the population unemployed- 10% of the population unemployed - Life expectancy (Male : 78 years / Female : 85 - Life expectancy (Male : 78 years / Female : 85

years)years)

OSTRODA 30/05/2012OSTRODA 30/05/2012

The health system in The health system in FranceFrance

Some figures about the health Some figures about the health systemsystem

-Health expenditures 11% GNBHealth expenditures 11% GNB

-Budget of Social Security : 280 Billions EurosBudget of Social Security : 280 Billions Euros

-3500 Euros health expenses per person per year3500 Euros health expenses per person per year

-8% of the population works in the healthcare sector8% of the population works in the healthcare sectorOSTRODA 30/05/2012OSTRODA 30/05/2012

The health system in The health system in FranceFrance

1945 : Social Security is settled 1945 : Social Security is settled (health, retirement, work accident, maternity)(health, retirement, work accident, maternity)

The system is :The system is : - universal (open to everyone)- universal (open to everyone) - global ( all the health problems)- global ( all the health problems) - build on solidarity (as insurance)- build on solidarity (as insurance) - share managed (governement and unions)- share managed (governement and unions)

It includes :It includes : - a general insurance (refunding about 80% of the expenses)- a general insurance (refunding about 80% of the expenses) - a private insurance (refunding about 15% of the expenses)- a private insurance (refunding about 15% of the expenses) - government funds (homeless and illegal immigrants)- government funds (homeless and illegal immigrants)

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The health system in The health system in FranceFrance

Financing the system Financing the system - Previously a Bismarckian system (based on Previously a Bismarckian system (based on

taxes for workers)taxes for workers)

- Moved to a mix systemMoved to a mix system (a part from the workers taxes and part from (a part from the workers taxes and part from

thethe income taxes) 70/30income taxes) 70/30OSTRODA 30/05/2012OSTRODA 30/05/2012

The health system in The health system in FranceFrance

The specify of the system The specify of the system A mixture between public and private wayA mixture between public and private way

- Physicians, private hospitals, chemistries are working on Physicians, private hospitals, chemistries are working on a private (liberal) way a private (liberal) way

- Public hospitals, medical universities, research Public hospitals, medical universities, research laboratries are working on a public (civil servant) way laboratries are working on a public (civil servant) way

- The money is coming from the same place (Social The money is coming from the same place (Social Security) but each group is paid differentlySecurity) but each group is paid differently

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The health system in The health system in FranceFrance

A very centralised system run by the A very centralised system run by the governementgovernement

- Ministry of Health- Ministry of Health

- Regional branches of the Ministery- Regional branches of the Ministery

- Specialized agencies (Drug, quality, food, - Specialized agencies (Drug, quality, food, equipment,..)equipment,..)

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The health system in The health system in FranceFrance

The figures The figures

- 3 000 Hospitals- 3 000 Hospitals - 2500 Nursing homes- 2500 Nursing homes - 1500 Disabeled homes- 1500 Disabeled homes

- 800 000 public health workers- 800 000 public health workers - 200 000 private health workers (physicians, - 200 000 private health workers (physicians,

nurses,nurses, physiotherapists, …) paid on a liberal wayphysiotherapists, …) paid on a liberal wayOSTRODA 30/05/2012OSTRODA 30/05/2012

The health system in The health system in FranceFrance

In summaryIn summary According to the World Health Organisation, According to the World Health Organisation,

the French system is considered as the the French system is considered as the « best » of the world« best » of the world

But it is quite expensive (cumulated Social But it is quite expensive (cumulated Social Security debt : 150 Billions Euros)Security debt : 150 Billions Euros)

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Problemes and solutions Problemes and solutions developed during the last 30 developed during the last 30

yearsyears The main problem : The main problem :

- the deficit of the SS- the deficit of the SS every year between 5 and 10 billionsevery year between 5 and 10 billions (2011 : 11 billions)(2011 : 11 billions)

the cumulated debt : 140 Billions Eurosthe cumulated debt : 140 Billions Euros

The basic solution :The basic solution : Increasing the incomes / Decreasing the expensesIncreasing the incomes / Decreasing the expenses

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Problemes and solutions Problemes and solutions developed during the last 30 developed during the last 30

yearsyears The cause of the problemThe cause of the problem The infernal triangle The infernal triangle The Patient (using) The Patient (using)

The Physician (advising) The Social Security (paying)The Physician (advising) The Social Security (paying)

No Control / No RegulationNo Control / No Regulation

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Problemes and solutions Problemes and solutions developed during the last 30 developed during the last 30

yearsyears The other problemsThe other problems

- The new technologiesThe new technologies

- More and more older peopleMore and more older people

- The development of the chronical diseasesThe development of the chronical diseases

- The medical « demography »- The medical « demography »OSTRODA 30/05/2012OSTRODA 30/05/2012

Problemes and solutions Problemes and solutions developed during the last 30 developed during the last 30

yearsyears An old systemAn old system - build in the fifties- build in the fifties - during a good economical- during a good economical - more simple- more simple

Nobody want that the system changesNobody want that the system changesIt is politicaly dangerous to open the It is politicaly dangerous to open the

questionquestionOSTRODA 30/05/2012OSTRODA 30/05/2012

Problemes and solutions Problemes and solutions developped during the last 30 yearsdevelopped during the last 30 years

More than 10 reforms during the last 30 More than 10 reforms during the last 30 yearsyears

(1976,1979,1981,1982,1986,1988,1990,1991,1(1976,1979,1981,1982,1986,1988,1990,1991,1995,995,

2001,2004,2009)2001,2004,2009)

The main purpose : to cut the deficitThe main purpose : to cut the deficit

The same result : mainly unefficientThe same result : mainly unefficient

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A new health law : A new health law : HPSTHPST

The law « Hôpital, Patients, Santé, Territoire »The law « Hôpital, Patients, Santé, Territoire » 2009 / Minister Mme Bachelot2009 / Minister Mme Bachelot A large reform reorganizing partly the health systemA large reform reorganizing partly the health system with :with :

- Creation of the Regional Health Agencies- Creation of the Regional Health Agencies - Promoting Health Education- Promoting Health Education - Enlarging health access to everyone- Enlarging health access to everyone - Starting a new management method in the hospital- Starting a new management method in the hospital

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A new health law : A new health law : HPSTHPST

A new governance in the hospitalsA new governance in the hospitals

« It is necessary to have only one boss in the hospital »« It is necessary to have only one boss in the hospital » Mr SarkozyMr Sarkozy

Previously competion between the head of the physicians Previously competion between the head of the physicians and the « administrative » directorand the « administrative » director

Now the big boss is the « administrative » director with Now the big boss is the « administrative » director with different groups to help him (Board of Directors, different groups to help him (Board of Directors, « Vigilance Committee », Medical Commission, …)« Vigilance Committee », Medical Commission, …)

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A new health law : A new health law : HPSTHPST The resultsThe results

The law has been partly « used »The law has been partly « used »Opposition of the physiciansOpposition of the physiciansHealth education is still an ideaHealth education is still an idea

but the Regional Health Agencies are very but the Regional Health Agencies are very powerfull and quite efficientpowerfull and quite efficient

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And what about the And what about the hospital managers ?hospital managers ?Difficult timesDifficult timesThe goal : « Deficit is prohibited »The goal : « Deficit is prohibited »-Better organisationBetter organisation-Higher productionHigher production-More efficiencyMore efficiency

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And what about the And what about the hospital managershospital managers A problem of trainingA problem of training

- Most of the hospital managers are Most of the hospital managers are coming from an « administrative coming from an « administrative school  »school  »

- Lack of knowledge in management Lack of knowledge in management and business administrationand business administration

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And what about the And what about the hospital managers ?hospital managers ? New valuesNew values

Before : Non profit / Public serviceBefore : Non profit / Public service

Now : Liberal / Efficiency / »Profit »Now : Liberal / Efficiency / »Profit »

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And what about the And what about the hospital managershospital managers The blockages in the hospitalThe blockages in the hospital

- Civil servants- Civil servants - Unions- Unions - Lobbies opposition- Lobbies opposition - Power and delegation- Power and delegation

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And what about the And what about the hospital managershospital managers The answers of the governanceThe answers of the governance - - A better training, especially in business A better training, especially in business

administration administration

- Hospital managers can be hired from - Hospital managers can be hired from universities and private sectoruniversities and private sector

- Creation of ANAP ( National Agency for the - Creation of ANAP ( National Agency for the help in efficiency)help in efficiency)

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PerspectivesPerspectives Half the wayHalf the way

- Will everyone be able to reach Will everyone be able to reach the end of the tripthe end of the trip

Example (France Telecom)Example (France Telecom)

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PerspectivesPerspectives What about the health to morrow ?What about the health to morrow ?

The crisisThe crisis

The degrowthThe degrowth

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