Establishing Primary Care in France is a Struggle

A recent report commissioned by three ministries describes the effort to establish a primary care network in France to have “run out of steam.” (le dispositif de premier recours est à bout de soufflé). “An Assessment of Medical Homes and Health Centers and Plans for their Deployment” was released January 19, 2010. The report found that very few general practitioners were trained to do primary care and that there were few elements in the overall system that could support the development of multidisciplinary care offered in medical homes or primary care centers.

The term “primary care” itself is not really recognized in France and there are a number of alternative terms used to describe what it might become. New proposals to develop “medical homes” and ambulatory care centers have struggled to gain traction as the French system does not have the traditions or infrastructures to support group practice involving the coordination of care centered on the patient. The recent HPST law anticipates an emphasis on primary care as one way to improve access in disadvantaged areas. This latest report called for incentives to create primary care structures in the low-income suburbs and rural communities.

The report also called for a more practical and specific description of the “medical homes” and primary care (or its French equivalent) as a “brand” to which professionals will relate. This should be accomplished under the new Agences Regionales de Santé (ARS). A new legal framework is also necessary that allows the roles and missions of each of the collaborative professionals to be understood and accommodated.

Paying for care in these new structure will also require new mechanisms especially to balance the payments to nurses and supporting personnel. Bundled payments and incentive systems need to be developed and, again, the ARS regional agencies for health are to have a role in the payment structure. The new medical homes and centers also should be seen as places where multi- and pluri-disciplinary professionals can be trained.

For the full report see: www.sante-jeunesse-sports.gouv.fr/IMG/pdf/rapport_maison_de_sante.pdf