Pharmacies and bond loans

According to data released by the Ministry of Health on October 13, 33% of pharmacies have taken out bond loans. This figure has drawn government attention to the growing financialization of healthcare services.

Private equity in healthcare

In other healthcare sectors, private investment is already substantial. Six major groups control 62% of medical testing sites, and 30 to 35% of imaging centers are owned by financially integrated groups. Between 2020 and 2024, over 4 billion euros were invested in healthcare by private equity funds.

Government response plan

Health Minister Stéphanie Rist and SMEs and Commerce Minister Serge Papin introduced a ten-measure plan to address the issue. The plan focuses on supporting healthcare professionals' financing choices, preserving their independence, and increasing transparency in financial structures.

Preserving professional independence

Rist emphasized that the independence of healthcare professionals is non-negotiable. However, the government aims to better regulate financial practices rather than ban investors entirely. The goal is to ensure the capital needed for modernizing healthcare services remains available.

Limitations of current regulation

The financialization of pharmacies highlights the limitations of current regulations. Bond loans allow external investors to influence pharmacies' economic decisions without acquiring ownership. This raises concerns about the actual independence of pharmacy owners facing creditor demands.

Future regulatory framework

To address these concerns, the government plans to develop a doctrine on the functioning and governance of liberal practice companies (SEL) by the first quarter of 2027. This framework will be created with input from professional orders, investors, and a qualified individual, aiming to define practices compatible with professional independence.

Clarifying investor involvement

The government also aims to define compatible structures and clarify the limits of investor involvement. This is particularly important in light of recent court decisions that have shaped the legal landscape surrounding such investments.

Gradual regulatory approach

The government prefers a gradual approach, avoiding immediate legal changes. Any potential adjustments to the legal framework will be proposed after consultation with stakeholders, allowing time for compliance and adaptation.

Strengthening professional oversight

The plan includes strengthening the control powers of professional orders, such as that of pharmacists. A decree, expected in the first quarter of 2027, will specify procedures for verifying the legal and financial structures of SEL companies.

National alert mechanism

A national alert mechanism will be established to allow professionals to report violations of their independence. Professional orders and unions will help implement this system, ensuring confidentiality and protection for whistleblowers.

Enforcement and sanctions

Despite these measures, the government has not yet announced specific coercive actions for addressing irregularities. The focus remains on developing a doctrine and regularizing practices rather than introducing new sanctions.

Balancing regulatory challenges

The government acknowledges the difficulty of intervening against problematic structures without disrupting essential healthcare services. A mapping of "systemic" actors will be developed by the second quarter of 2027 to better understand the impact of such interventions.

Tracking financial involvement

A declarative register of shares held in SEL and financial participation companies of liberal professions (SPF-PL) will be created in 2027 by the national health insurance fund (Cnam). This system will help identify links between practice structures and organizations.

Monitoring financialization

A national observatory of financialization, attached to the Direction of Research, Studies, Evaluation and Statistics (Drees), will be established in the first quarter of 2027. It will monitor financialization trends and bring together various stakeholders.

Lack of comprehensive data

The government admits that current data are insufficient to fully understand the extent and consequences of financialization in healthcare. This highlights the need for more detailed monitoring and research.

Supporting professional development

The government plans to support healthcare professionals in managing their economic challenges. Resources on business management and financing will be developed, accessible through the Entreprendre portal. A mentoring network will be established by the end of 2026.

Pharmacy transfers and succession

Serge Papin encourages pharmacy owners to consider succession plans, particularly involving their employed pharmacists. This is seen as a way to ensure continuity and stability in the sector.

Regulating rather than restricting

The government's approach focuses on regulating investors rather than limiting their presence. The success of this strategy will depend on the rules adopted and their enforcement in practice.

Supporting cooperative structures

Serge Papin supports cooperative structures that allow pharmacists to pool resources without falling under the influence of investment funds. However, the tax treatment of these structures remains to be decided through parliamentary debate.