Continuity of Care/Maisons Medicale de Garde

I have learned that the structure of primary care services in France is very complex and grows in complexity almost daily. As I have said before, primary care is not quite a cohesive concept in France. There is no consensus translation for what we, in the US think is a fairly fundamental component of our health system—no matter that we still argue about it. In France, health policy people are a little uncomfortable when confronting the idea and that may be because they spend more time building the structure of health care delivery than arguing over its principles.

The newest wrinkle I discovered in French ambulatory care delivery is the “Maison Medicale de Garde” (MMG). I encountered this as part of a “jury” assessing a masters paper submitted by a student at the EHESP. Amandine Vial’s paper: “Collaboration between primary care and emergency services: medical home at Ploermel, Britanny,” was a case study of a MMG in the northwest part of France.

The MMG is not completely new, it grew from a general need to maintain continuity of care (permanence des soins) which the French recognized as a challenge in their system. Doctors were “disengaging” themselves from the practice of round-the-clock coverage. Many towns and rural areas simply had nowhere for patients to go after 6 pm and before 9 am except an emergency room. The Descours Report of 2003 called for a system or structure to assure continuity of care “de ville”—meaning, more or less, in the community.

The MMG structure is a cooperative, local agreement among mostly general practitioners and a local hospital to provide coordinated coverage for out-of-hours patients.

Paris has four MMGs, which seems a bit too few for a city of its size. But that’s because there are other options for out of hours care in the capital city. In smaller towns and cities, this may be the only after hours access point.

There is a charge for this kind of care, from 42€ for a weekend visit up to 63€ for evenings. Most French citizens are covered by their mutuelle or eligible for a reduced rate one-third of the full charge.

Continuity of care (permanence des soins) is a concept embedded in French public health law, as Amandine Vial pointed out in her masters paper. It is also a “notion évolutive” or a work in progress. Who is responsible for after hours care remains a controversial subject and some would say that the MMG is a way for some doctors to duck the issue.