Market reforms in the French healthcare system: between regulation and yardstick competition

Abstract

French cost-containment measures that traditionally consisted of price-control and a reduction in health care benefits have had a limited impact on the growth of health expenditures. Though the government pledged to cut the public deficit from 7.7% of the gross domestic product (GDP) in 2010 to 3% by 2013, thereby responding to EU Normative power (Diez, 2013), health expenditures continue to rise, since public demands are higher and more social problems are handled in the health care setting. With French budget deficit threatening France's credit rating, and therefore its membership within the EEC, novel instruments were needed. These included corporate management recipes (e.g. pay for performance contracts, patient volume targets, management by objectives, strict medical reviews and guidelines), new compensation mechanisms (e.g. activity-based accounting; a nationwide scale of health care costs) and far-reaching laws (e.g. the 2009 HPST bill). In the restructuring of health services, a French welfare elite pursued a hybrid strategy, regulating quasi-markets of care providers while creating supportive conditions for a vibrant private hospital sector and endeavored to streamline the delivery -rather than the financing -of health services.

Health Care Reforms, Power Concentration, and Receding Citizen Participation

“…However, PPPs are shunned as they have failed to meet expectations, particularly in the construction of public hospitals. 26 French public health organizations also experienced more horizontal consolidation than de-amalgamation strategies and more regulation of health services than competition between providers. As in other tax-funded health systems in Southern Europe, 27 reforms strengthen territorial networks and coordination of public or private care providers.…”