With the French presidential election just around the corner, now’s the time to take a look at the potential impacts the top candidates could have on healthcare in France. The incumbent, Sarkozy, has overseen dramatic changes in France’s healthcare system over the last few years with the implementation of the regional ARS reforms, significant cost containment on pharmaceuticals, and upheavals such as the withdrawal of Mediator. According to the latest polls, the top 3 candidates are Francois Hollande (Socialist Party), Nicolas Sarkozy (Union for a Popular Movement), and Marine Le Pen (National Front Party).
Pharma Industry Impact: French Healthcare Programs Tend to Focus on Drug Consumption
- Price Cuts Targeted by the Top Candidates Following the different waves of drug delisting from the reimbursement system or cuts in the levels of reimbursement, it's interesting to note that aside from Hollande and Sarkozy – who both mentioned price cuts in their program, with an estimated € 4 billion savings for Sarkozy – no other candidate plans any specific measures directly related to drug prices or reimbursement; measures that are extremely unpopular both among the population and also among the pharmaceutical industry. Perhaps more surprisingly, Marine Le Pen actually plans to potentially again reimburse drugs that were previously withdrawn from the reimbursement list.
- Actions Should be Taken on Volumes/Consumption Whilst reimbursement or drug prices are not targeted by the top candidates only, limitations on volume and drug consumption are generally a priority. Several candidates agree that actions at this level should be taken, notably:
— Better control of unnecessary prescriptions of drugs and tests for Sarkozy (€1.5 billion of savings)
— No waste when treatments are prescribed for Le Pen. Prescriptions should cover no more than the treatment period. This could imply that product packaging is reviewed by the pharmaceutical industry. Although no specific details are provided, it could require that unitary packages or small ones are created, even for the retail market.
Those pressures on drug consumption will certainly impact the pharmaceutical industry. It also remains to be seen if those limitations will be taken into account for price negotiations when drugs are launched, since volume-agreements play such a significant role in France. Surprisingly, no candidates mention an increase in the use of generics volumes as a means of cost containment, despite the fact that it is generally agreed that more could be done to encourage prescription of generic alternatives.
Physicians’ Compensation: Regulation and Limitation of Physicians’ Extra-billing
Le Pen, Hollande and Sarkozy all agree on the fact that physicians’ extra-billing should be legislated. While the French Public Health Authority sets the basis for reimbursement for consultations and acts, some physicians are allowed to significantly exceed this basis. Prices of at least one out of four physicians exceed the basis for reimbursement, says a survey published by the Public Health Insurance. This level raises up to 40% for specialists and even to 85% for certain surgeons. What’s more, prices are on average 54% above the basis for reimbursement and can reach 150% in certain regions (notably Paris). The extra-billing accounts for €2.5 billion.
Significant Post-election Reorganisation of French Healthcare System
- Creation of Specific Units to Treat Non Emergency Health Issues in Hospitals The majority of the candidates agree on the fact that emergency units at hospitals are not optimized. It is fairly common for people accessing the emergency unit to wait for more than 5 hours before seeing a physician. As such, several candidates mention that an area close to the emergency units should be created in a bid to treat people suffering from standards health issues.
Major Changes Come from Candidates Not Included in the Top 3 Jean-Luc Melenchon (Left Front), but also Hollande, plan to modify the DRG system for public hospitals, the latter stating that hospitals should not be regarded as private firms, while François Bayrou (Democratic Movement) plans to reform the Hospital, patients, health, and territories French bill (HPST law), a bill intended to modernize hospitals.
Bayrou is focusing on the specific healthcare insurance in place in the Alsace-Moselle region. This independent institution has a solid financial situation. As such, this model could be expanded to the whole country. However, there are two major downsides. First, this will have a negative impact on private health insurance companies playing a significant role in France. Second, this will increase mandatory taxes for the whole population.
Given the current context of crisis, candidates are primarily focusing on limiting healthcare expenditure:
- Better control of drug prescriptions and volumes delivered
- Legislation and limitation of physicians’ extra-billing. This would allow significant savings and will probably please the population as well as private health insurances that increasingly have to bear the costs of those co-payments
Limitation of fraud is also a priority, albeit to a lesser extent
The top candidates tend to focus on measures that have proven to be efficient. For instance, the prescription control scheme triggered higher than expected savings in 2011. As a consequence, if Hollande or Sarkozy are elected it is very likely that no major changes will be implemented, but that restrictions on drug prices and volumes will continue.
Things could be different with candidates who are, at least at the moment, not leading the race: price cuts and drug delisting are not mentioned in their programs and they are more likely to implement major changes in the healthcare sector.