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V Miedzynarodowa Konferencja « Managing in Times of Crisis  »

V Miedzynarodowa Konferencja « Managing in Times of Crisis  ». The current changes to the health system in France How hospital managers have responded Bertrand BAILLEUL CEO Hôpital Saint Jean (Paris) President European Health Managers Forum. The health system in France.

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V Miedzynarodowa Konferencja « Managing in Times of Crisis  »

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  1. V MiedzynarodowaKonferencja«Managing in Times of Crisis » The current changes to the health system in France How hospital managers have responded Bertrand BAILLEUL CEO Hôpital Saint Jean (Paris) PresidentEuropeanHealth Managers Forum

  2. The health system in France Some figures about France : - Population : 65 Millions (70% urban/23% rural) - 5th economical country in the world - GNP : 2 000 Billions Euros - National budget : 280 Billions Euros - Public debt : 1 700 Billions Euros - 10% of the population unemployed - Life expectancy (Male : 78 years / Female : 85 years)

  3. The health system in France Some figures about the health system • Healthexpenditures 11% GNB • Budget of Social Security : 280 Billions Euros • 3500 Euros healthexpenses per person per year • 8% of the population works in the healthcaresector

  4. The health system in France 1945 : Social Security issettled(health, retirement, work accident, maternity) The system is : - universal (open to everyone) - global ( all the healthproblems) - build on solidarity (as insurance) - sharemanaged (governement and unions) It includes : - a generalinsurance (refunding about 80% of the expenses) - a privateinsurance (refunding about 15% of the expenses) - governmentfunds (homeless and illegal immigrants)

  5. The health system in France • Financing the system • Previously a Bismarckian system (based on taxes for workers) • Moved to a mix system (a part from the workers taxes and part from the income taxes) 70/30

  6. The health system in France • The specify of the system A mixture between public and privateway • Physicians, privatehospitals, chemistries are working on a private (liberal) way • Public hospitals, medicaluniversities, researchlaboratries are working on a public (civil servant) way • The money iscomingfrom the same place (Social Security) but each group ispaiddifferently

  7. The health system in France • A verycentralised system run by the governement - Ministry of Health - Regional branches of the Ministery - Specializedagencies (Drug, quality, food, equipment,..)

  8. The health system in France • The figures - 3 000 Hospitals - 2500 Nursing homes - 1500 Disabeled homes - 800 000 public healthworkers - 200 000 privatehealthworkers (physicians, nurses, physiotherapists, …) paid on a liberalway

  9. The health system in France • In summary According to the World Health Organisation, the French system isconsidered as the « best » of the world But itisquiteexpensive (cumulated Social Security debt : 150 Billions Euros)

  10. Problemes and solutions developedduringthe last 30 years • The main problem : - the deficit of the SS everyyearbetween 5 and 10 billions (2011 : 11 billions) the cumulateddebt : 140 Billions Euros The basic solution : Increasing the incomes / Decreasing the expenses

  11. Problemes and solutions developedduringthe last 30 years • The cause of the problem The infernal triangle The Patient (using) The Physician (advising) The Social Security (paying) No Control / No Regulation

  12. Problemes and solutions developedduring the last 30 years • The otherproblems • The new technologies • More and more older people • The development of the chronicaldiseases - The medical « demography »

  13. Problemes and solutions developedduring the last 30 years • An old system - build in the fifties - during a good economical - more simple Nobodywantthat the system changes It ispoliticalydangerous to open the question

  14. Problemes and solutions developpedduring the last 30 years • More than 10 reformsduring the last 30 years (1976,1979,1981,1982,1986,1988,1990,1991,1995, 2001,2004,2009) The main purpose : to cut the deficit The sameresult : mainlyunefficient

  15. A new healthlaw : HPST • The law « Hôpital, Patients, Santé, Territoire » 2009 / Minister Mme Bachelot A large reformreorganizingpartly the health system with : - Creation of the RegionalHealthAgencies - PromotingHealth Education - Enlarginghealthaccess to everyone - Starting a new management method in the hospital

  16. A new healthlaw : HPST • A new governance in the hospitals « It isnecessary to have only one boss in the hospital » Mr Sarkozy Previouslycompetionbetween the head of the physicians and the « administrative » director Now the big boss is the « administrative » directorwithdifferent groups to help him (Board of Directors, « Vigilance Committee », Medical Commission, …)

  17. A new healthlaw : HPST • The results The law has been partly « used » Opposition of the physicians Healtheducationisstill an idea but the RegionalHealthAgencies are verypowerfull and quite efficient

  18. And what about the hospital managers ? Difficult times The goal : « Deficitisprohibited » • Better organisation • Higher production • More efficiency

  19. And what about the hospital managers • A problem of training • Most of the hospital managers are comingfrom an « administrative school  » • Lack of knowledge in management and business administration

  20. And what about the hospital managers ? • New values Before : Non profit / Public service Now : Liberal / Efficiency / »Profit »

  21. And what about the hospital managers • The blockages in the hospital - Civil servants - Unions - Lobbies opposition - Power and delegation

  22. And what about the hospital managers • The answers of the governance - A better training, especially in business administration - Hospital managers canbehiredfromuniversities and privatesector - Creation of ANAP ( National Agency for the help in efficiency)

  23. Perspectives • Half the way • Will everyonebe able to reach the end of the trip Example (France Telecom)

  24. Perspectives • What about the health to morrow ? • The crisis • The degrowth +++++++++++++

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