France's health system faces stark inequalities and inefficiencies, with 12% of national wealth spent on health yet poor outcomes. Reforms could focus on measuring outcomes, not just processes.
Health care a major concern in France
Health care is one of the top concerns for French voters in every presidential election, yet it often remains on the sidelines of political debates. The discussions tend to focus on resource allocation, such as the number of hospital beds, doctors, and budgets, rather than deeper issues.Disparities in health outcomes
A significant issue is the uneven quality of health outcomes across France. Postal codes strongly influence survival chances, with regions like Hauts-de-France showing an excess mortality rate over 20% compared to the national average. Rural areas face even greater disparities, and neonatal mortality has dropped from sixth to twentieth place in Europe, mainly in disadvantaged regions.Inconsistent quality control
Despite systems in place to evaluate health care quality, such as certification and accreditation, they rarely assess whether patients are actually improving. France is classified by the OECD as a country with "emerging use" of patient-reported outcomes, unlike 24 out of 38 other countries that systematically collect such data.Overuse of medical resources
French health care also suffers from overuse of medical resources. Nine out of ten doctors admit to prescribing unnecessary tests or procedures. France uses nearly 70% more antibiotics than the OECD average, and many prescriptions do not follow guidelines. About 265,000 hospitalizations per year could be avoided, including half for heart failure.Payment system driving inefficiency
The current payment system, which rewards volume over quality, contributes to these inefficiencies. A reform is possible without increased spending, but it would require breaking from the status quo. One key change would be giving general practitioners a central role in coordinating care and managing chronic diseases.New payment model for GPs
A mixed remuneration model for general practitioners, combining a fixed amount with a part tied to quality, could help. This would recognize their work in coordination and prevention, which is currently undervalued. Health centers equipped with diagnostic tools could provide non-emergency care and reduce hospital pressures.Leveraging existing data systems
France already has the National Health Data System (SNDS), which covers the entire population. Simplifying access to this data would allow teams in both towns and hospitals to compare their performance with peers. This could help GPs track readmission rates or compare antibiotic prescriptions with colleagues.Patient feedback as a tool
A platform like My Health Space could collect patient feedback outside of consultations, providing insights into their health status. This would help identify areas for improvement and support better decision-making.Measurement as a learning tool
Results should be used as a learning tool rather than a means of punishment. In countries like the Netherlands and Sweden, transparency has led to improved care quality. France could follow this model by sharing results confidentially first and then gradually publishing them to encourage improvement.A call for political will
What France lacks is not medical expertise or money, but the political will to measure and improve patient care. The goal should be to provide caregivers with the tools they need to deliver high-quality care, ensuring that proximity to patients does not come with mediocre results.
