HealthDataNavigator Assess available data on different performance domains across various settings

France

Population (2011): 63,249,090
GDP per capita, US$ PPP at current prices (2011) 35,133.5
Health expenditure per capita, US$ PPP (2010): 3,974
Life expectancy at birth, years (2010): 81,4

Health System Data in France

Main sources of data in the French healthcare system are the Ministry of Health for hospital care and the statutory National Health Insurance Fund for ambulatory care. This division reflects the fact that the Ministry has historically been responsible for hospitals’ regulation while the National Health Insurance Fund steers relations with ambulatory care physicians and is the main funder of the overall healthcare system. For a long time, regulatory power has been very centralized in these institutions and so has information production. However, reforms in 2009 initiated a regionalization process with the creation of Regional Healthcare Authorities whose aim is to integrate ambulatory, hospital and social services around cross-sectorial patient pathways.

Health Status

Aggregate data

  • INSEE (National Institute of Statistics and Economic Studies) : demographic data on birth and fertility rates, mortality and life expectancy
  • CépiDc : death causes are reported by the national medical research center network INSERM.
  • Ecosanté IRDES : diseases prevalence. National longitudinal datasets from 1950 to 2010. There also exists a regional version of the same datasets which breaks down information local administrative units from 1968 onwards.
  • Score Santé: basic health indicators calculated at regional level, database hosted by the National Federation of Regional Health Observatories (FNORS)
  • STATISS : demographics and healthcare provision at local level. Webpages hosted by the Ministry of Health offer a user-friendly mapping system
  • Réseau Sentinelles : compilation of large epidemiological data on communicable diseases, with anonymous individual description of cases for surveillance and research. Provide prevalence of a variety of communicable diseases that are subject to particular scrutiny by the health authorities such as measles, mumps, influenza-like illnesses, and hepatitis but also asthma. This network is currently constituted of approximately 1300 volunteers general practitioners (GPs), working throughout the metropolitan regions of France (2% of the total GPs in these regions). Data is presented on a weekly basis and by local administrative unit. Available in English.
  • Institut de Veille Sanitaire (InVS) : the agency responsible for epidemiological surveillance and disease control, holds several registries, for certain pathologies such as infectious diseases, cancer, meningitis, tuberculosis, HIV/AIDS

Individual level data

  • Health, Healthcare and Insurance Survey (ESPS): hosted by IRDES. Self-reported health indicators (Mini European module) since 2004 and morbidity. pfeil zu        
  • Baromètre santé surveys: by the National agency for health promotion and hazards prevention (INPES) since 1992. Focus on individual behaviors (screening, substance abuse, sexual behaviors etc.). pfeil zu
  • Enquête décennale de santé, carried out by the INSEE approximately every 10 years. Self-reported health and morbidity. pfeil zu
  • ENTRED is the surveillance system on diabetes which surveyed 10000 people in two rounds (2001-2003 and 2007-2010). Health status of people with diabetes.

Quality (valued outcomes)

  • Health, Healthcare and Insurance Survey (ESPS), contains a couple of questions on the experience of patients relative to the last visits to a GP/specialist (waiting time, responsiveness). pfeil zu
  • Baromètre santé surveys hosted by the national agency responsible for health promotion and hazards prevention (INPES) have a component addressed to general practitioners and pharmacists, in which prevention, health promotion, patient education and screening are assessed. pfeil zu
  • ENTRED survey directed at people with diabetes has several questions on perceived quality of care by the patients, and healthcare system responsiveness, while a questionnaire addressed to medical practitioners informs on their practice style.
  • PLATINES provides data, at hospital-level, on a set of safety and quality indicators (nosocomial infections, patient information, safety measures) and enables comparison between hospitals.
  • ICALIN provides composite indicators at hospital-level on safety process and nosocomial infections

Efficiency/Economy

Physical Inputs (infrastructure)

Aggregate data

  • The INSEE website has a variety of studies and statistics available on ambulatory healthcare professionals' demographics, hospitals and equipment
  • Eco Santé IRDES data on healthcare supply, available at the national and regional levels: health professionals, pharmaceutical industry, community pharmacies, private and public hospitals, long term and nursing care and expensive technical equipment
  • STATISS presents regional and local level data on hospital and primary healthcare capacity, with preset tables enabling easy benchmarking between regions. Hosted by the Ministry of Health.
  • Statistique Annuelle des Etablissements, which is a complete census of public and private (for profit and not for profit) hospitals since 2004, provided by the Ministry of Health. The primary data source for hospital infrastructure and equipment. pfeil zu
  • PLATINES ward-level information on hospitals, capacity and equipment with a few process quality indicators hosted by the Ministry of Health

Activity/Utilization

Aggregate data

  • Eco Santé IRDES at the national and regional levels: detailed information on hospital and outpatient activity (procedures, doctor visits, number of hospital admissions, average lengths of stay…)

Individual level data

  • Health, Healthcare and Insurance Survey (ESPS), contains detailed questions on healthcare utilization, health insurance, forgone care, etc. by socio-economic status pfeil zu
  • SNIIR-AM reimbursement database of the National Health Insurance Fund. Exhaustive data on ambulatory care consumption (consultations, diagnostic tests, technical procedures, pharmaceuticals) and private hospitals' activity. Consumptions in public hospitals are in since 2006. pfeil zu
  • PMSI hospital database maintained by ATIH (Technical Agency for Hospital Information). Data on hospitals' activity by case mix (DRG system). Data is available for 4 care settings : for acute care from 1996, covering medical, surgical and obstetrics wards (médecine, chirurgie, obstétrique); for post-operative and rehabilitation care since 1999; for psychiatric care since 2006 and for hospital at home (hospitalisation à domicile) since 2008. pfeil zu

Cost and Expenditure

Aggregate data

  • Eco Santé IRDES at the national and regional levels : fees for practitioners in ambulatory sector, providers' income, macro-level expenditure data by source of funding and by setting and provider
  • National Health Accounts are published every year by the research and statistics branch of Ministry (DREES) : macrolevel data on main sources of healthcare financing and expenditure areas

Individual level data

Access/Equity

Individual/Person level data

Non-health care determinants

Aggregate data

Individual/Person level data

  • Baromètre santé surveys has been designed specifically to study non healthcare determinants of health (addictions, nutrition, physical activity, occupational risk factors) pfeil zu
  • Health, Healthcare and Insurance Survey (ESPS), contains several questions related to behavioral and occupational determinants of health status (BMI, alcohol, tobacco consumption, activity, etc.) pfeil zu
  • Enquête décennale de santé, contains questions on individual life style and working conditions susceptible to influence healthcare needs and utilization. pfeil zu
  • ENTRED survey directed at people with diabetes has several items on non-healthcare determinants

 

Health System Design and Context

Historically a Bismarckian statutory-based health insurance social protection system, in the past few decades there has been a tendency towards uniform and universal medical coverage. Over 77% of the overall healthcare system is currently funded by the Social Security. Copayments are mostly funded by private complementary health insurance that also fills the gaps in Social Security funding in some areas such as dentistry and prescription glasses (over 90% of the French population has bought such additional coverage). Most ambulatory care health professionals are independent workers that are paid on a fee-for-service basis, including specialist doctors. Alongside public hospitals funded with the French activity-based DRG system, private inpatient treatment centers are also very present.