Telemedicine in France

France’s health and care system organisation

The French healthcare system is supported by a pluralistic organization of health care provision. This organization is based on a network of multiple structures, particularly in the hospital field consisting in three types of institutions: public hospitals, non profit hospitals and private clinics. As far as actors are concerned they include liberal health professionals working in ambulatory healthcare system.

The health system is mainly piloted by public authorities at national level. Competences in public health and health care provision are spread over three levels.

National level: For the funding and organization of healthcare provision; a financing law adopted by the parliament defines objectives for health expenditure per year and global provision based on health priority policy driven by health ministry. Public and private sectors are concerned.
Regional level: The regional health agencies (ARS) ensure:
- repartition of this provision between these 2 sectors,
- coordination of care,
- efficient management of resources and quality access to cares.
- adaptation of national policies to regional contexts taking into account country planning.
Local level: Under the ARS’ supervision healthcare actors organize themselves to facilitate patient’s management according to his/her situation.

France’s health and care system financing

The French health care system is funded in part by obligatory health contributions deducted from all salaries, and paid by employers, employees and the self employed; the global insurance health system is based on a “third party system” and a “patient’s contribution”(small fraction to be paid by the patient as regard to medical act cost).

France’s telemedicine strategy and legislation

The official announcement of telemedicine has been promoted by official law in July 2009. A decree published in October 2010 has defined the main telemedicine fields (teleconsultation, teleexpertise, telemomitoring, teleassistance and telesurveillance), the implementation of telemedicine (in particular authentification of health professionals involved in the telemedicine act, identification of the patient, access by the professionals to patient’s data) and telemedicine organisation (by programs, contracts or agreements). This decree has been inserted in the public health code, which is a way to consider, from legal point of view, telemedecine as a standard medical act (which adds to and does not replace current medical acts).

As far as strategy is concerned the Ministry of Health has identified five priority areas to facilitate the deployment of telemedicine in France and to move from a pioneering to a more effective phase. Guidelines are provided from central level to Health Regional Agencies (ARS) for the development and implementation of the regional programs of telemedicine, to set up contracts for the development of an organisation ensuring quality and security of care, and towards health professionals about their own engaged responsibilities in the development of telemedicine act.

An experimentation on financing telemedicine acts is going to be implemented in several regions and cities in health and medico-social fields (e.g. are concerned elderly, cares and service access, accommodation…). This should help finding a better repartition of teleservices on the territory and a better monitoring of patients at home, especially those who suffer from COPD.