Baby Steps to EHRs in France

France has decided to move completely toward electronic health records—and has committed to universal adoption of a “dossier médical personnel” (DMP). But before that can be done, the system has to get to where all bills are submitted electronically. In September, it was announced that a fine of up to 1 euro would be charged for every paper claim. The principle of this fine system was part of the new law: “Hospital, Patients, Santé, Territoires” (HPST), passed last summer.

In 2008, in France, 86% of clinical offices able to transmit claims transmit electronically but insurers received more than 150 million paper claims. Among physicians, nearly 20% of GPs and over 42% of specialists still used paper claims in 2008. The Mutalités (insurance companies) estimate that a paper claims costs over $2.40 to process while an electronic claim costs only 36 cents.

The fine system didn’t get implemented as planned and there are reports that it will happen this coming May and the fine will be only 50 euro cents.

Setting The Limit on Doctors in Training at 7,400 per year

France limits the number of students who are trained in medicine via the numerus clausus. This is a restriction on the number of students who are allowed to pass from the initial year of medical training into the 2nd year. Essentially, the top scorers on the end of year examination are allowed to move ahead.

The limit is set by the ministries of higher education and research health and sport and is set each year around this time. The official notice gets posted on "Legifrance" which posts all official decrees and order. The order for the numerus clausus was released January 21, 2010.

By Order of the Minister of Higher Education and Research and the Minister of Health and Sport dated January 21, 2010, the number of first year students of undergraduate medical studies allowed to continue their studies medicine at the termination of the courses following the tests of the academic year 2009-2010 is set at 7 400, divided between the following institutions.....

The 37 medical schools are then listed with their quotas. These range from 550 (Lille-combined universities) to 8 in New Caledonia and 23 in Corsica.

The ministries pay close attention to the numerus clausus as a mechanism for adjusting overall physician supply--an issue that came to the fore in the recent past as it was apparent that France was going to see a decline in overall number of practicing doctors.

The Observatoire National de la Démographie des Professions de Santé (ONDPS) was established in 2003 to monitor supply and needs for physicians. It strongly supported expanding the training pool.

The numerus clausus fell from a high of 8588 in 1971 to a low of 3500 in 1992. Since then it rose slowly through 2001 to 4100 but, on the heels of several predictions of a doctor shortage, has risen rapidly to the 7,400 level This is slightly less than the 8,000 that was predicted a few years ago as necessary to keep the supply in line with population growth and physician retirement patterns.

EHESP Joins with Other Institutions to Create a Research Consortium

In France there is a relatively unique approach to coordinating research and graduate education through a series of center for research and higher education, or “Poles de recherché et d’enseignement supérieur” (PRES). This mechanism was created in 2006 by the “Pacte sur la Recherche” and was intended to facilitate the process of decentralization in the research and academic community. This is part of a larger trend toward institutional autonomy promoted by the current government. Valerie Pecresse, French Minister of Higher Education and Research, described it this way in 2009:

The development of these centers of research and higher education naturally accompanies the gradual accession of our universities toward autonomy. In these centers, all of the actors in research and education can cooperate and unite their diverse forces to meet their common goals.

Since 2007, 16 PRES have emerged with the most recent being the Université Paris Cité – EHESP, Rennes the latest to organize. This consortium was approved in December and has 7 founding members:
EHESP, (École des Hautes Études en Santé Publique)
New Sorbonne University (Paris 3) www.univ-paris3.fr/
Paris Descartes (Paris 5) www.univ-paris5.fr/
Paris Diderot (Paris 7) www.univ-paris-diderot.fr/
Sciences Po www.sciences-po.fr
Inalco www.inalco.fr/
Institut Physique du Globe de Paris www.ipgp.fr/
Paris North University (Paris 13) (associate member) www.univ-paris13.fr

A summary of the programs and its aims is posted on the EHESP website in English (www.ehesp.fr/universite-paris-cite/). This structure will allow for more cross-disciplinary work in public health and allow students and investigators in a wide range of institutions to work jointly on projects.