France healthcare overview

France‘s health system is based on a two-tier health insurance system.

医疗保健支出主要由强制性公共医疗保险(57%)和自愿私人医疗保险(26%)提供资金。, with the remainder from other state taxes (10%) and patient out-of-pocket payments (7%)[1].

所有居民都必须向法定健康保险计划(SHI)支付约8%的工资。, managed by the social security agency la Sécurité Sociale. 大约90%的人口还拥有额外的(自愿的)私人健康保险(来自营利性或非营利公司),以弥补使用点医疗保健费用与公共健康保险报销金额之间的差距.

Healthcare is governed centrally by the Ministry of Health and Prevention, which plays a strong role in organising the health system and determining the operating conditions. 中央政府制定卫生保健预算,并通过财政拨款控制卫生保健支出的数额和方向 la Sécurité Sociale.

The delivery of healthcare at a local level is managed by 18 Regional Health Agencies (ARS). 每个区都有一个战略保健计划,将其保健预算分配给满足其人口需求的服务. In 2019, 医疗保健支出的最大类别是公立和私立医院的住院治疗(32%)和初级保健中心的门诊治疗, specialist services and dental care (28%)[1]. The ARSs created Regional Hospital Groups (Groupements Hospitaliers des Territoires - GHT) to integrate public health services within their regions.

The French health system is characterised by free choice of patients. 全科医生转介是专科护理的门户,患者(或他们的全科医生)可以选择转介给公立或私立专科医生. 

ARS通过分配授权,在其区域内提供和分配公共和私营服务方面发挥重要作用. ARS具有地方审批机构和监管机构以及管理公立医院的双重作用. 提供任何新的临床服务和设备(在医院和一些门诊服务)必须首先得到ARS的授权.  授权是有限的,以使ARS能够控制其区域内提供的临床服务量.

国家卫生局(HAS - Haute autorit de sant)对医生进行执业认证,并根据国家临床质量和安全标准对公立和私立医院进行独立认证.

Each year, la Sécurité Sociale determines the national fixed fees for pharmaceuticals, primary, specialist, hospital and dental care.

法国的大多数医疗保健服务都是根据诊断相关组(DRG)按服务收费进行报销的。, however this is starting to change.

Both public and private providers are on a fee-for-service rate by the government, calculated by diagnosis, procedure or service. 获得保健服务的病人可由其公共健康保险基金报销国家费用的80%至100%, regardless of whether they access services from a public or private provider. However, private doctors maycharge patients a higher fee than the state-determined rate. Hence, a large proportion of the population (approx. 90%) has additional private health insurance to cover any gap.

Doctors are categorised into three sectors that describe the fee-for-service they charge. 第一类医生收取国家固定费用,患者每次获得服务时将获得该费用的80% -100%的报销.  Most GPs are in this category. Sector 2 doctors are approved to charge a higher rate with “reason”. 患者可获得80%至100%的国家固定费用报销,并使用私人健康保险或自费共同支付差额. Most specialists are in this category. Sector 3 doctors have no fee limit. These are usually doctors practising in highly specialised areas of medicine.

医院收费(公立和私立)由中央政府按每位患者的固定费率(基于DRG)确定,以支付临床设施的固定费用, administration, nursing care and hotel services. 公立医院也按每个病人(按DRG)支付费用,但比私立医院高20%. 公立医院还获得额外的专项资金,用于与提供个人保健服务没有直接关系的活动, such as research and training.

如果病人选择使用私人房间或额外的酒店服务,私立医院会向他们收取额外费用, and this is usually covered by the patient’s private health insurance or self-funded. 私立医院还将从专科医生那里获得额外收入,专科医生向医院支付使用其设施的费用(即. theatres, consulting rooms) and for the provision of administrative services. 这是商定的费率,根据专科医生收入的百分比和他们从医院获得的额外服务水平(如咨询室)确定, administrative support etc.).

Mental health

国家政府已经引进了一种基于价值的模式,在这种模式中,医疗保健提供者根据他们为患者提供的价值获得补偿, rather than the volume of services they provide.

心理健康服务(2022年起)和康复服务(2023年起)采用按日收费的分层收费结构, 人口分配(基于该地区的社会经济地位和患者的敏锐度)和质量结果(报告的患者临床结果和经验). 

Providers of healthcare services

在法国,专业咨询师要么是个体经营者,在私立医院咨询,要么在公共系统工作. They very rarely work at both, although many self-employed specialists may work for a number of different private providers. Patients require a referral from their GP to access specialist services. 

The majority of specialists working at Ramsay Santé facilities are self-employed, with the exception of rehabilitation physicians and some psychiatrists. 自雇专家由政府或患者直接支付费用(患者将得到报销)。. 专家必须由医院临床管理部门授权在每家全国网赌正规平台桑特医院执业. 

[1] OECD State of Health in the EU-Country Health Profiles – France 2021

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全国网赌正规平台集团网站“全国网赌正规平台的市场”部分的信息基于从外部来源获得的信息,截止到2023年2月16日. Ramsay has not independently verified the information presented in this section. The information is in summary form and is not necessarily complete.

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