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France’s physicians are foundational to modern medicine. René Laennec invented the stethoscope in 1816. Jean-Martin Charcot joined Paris’s Salpêtrière Hospital in 1862 and founded modern neurology, documenting multiple sclerosis and Parkinson’s Disease. Louis Pasteur developed pasteurisation in 1864. Alexis Carrel trained with a seamstress to improve his surgical sewing, advancing vascular surgery and winning the Nobel Prize for Medicine in 1912.
Country’s healthcare system in a nutshell
France runs France’s universal coverage operates under a statutory health insurance (SHI) system providing universal coverage for its residents. The system is financed through employee and employer contributions, and increasingly by earmarked taxes on a broad range of revenues. The main schemes that provide SHI are one specific to the agricultural sector and another more general scheme, with the same coverage and benefit policies. Funds are pooled at the national level with the possibility of subsidies between schemes. Voluntary, complementary private health insurance (VHI) also plays a large role. Almost 95% of the population has VHI
Public vs private
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model. SHI’s wide coverage includes hospital care, physician services, long-term care, and prescription drugs. Patients are responsible for certain out-of-pocket expenses, such as coinsurance, copayments, and additional charges if fees exceed the covered amounts.
SHI funding is primarily from payroll taxes paid by both employers and employees, along with a national income tax and levies on specific industries and products. To offset out-of-pocket costs, 95% of French citizens also hold voluntary complementary private health insurance (VHI). It helps cover expenses for services like dental, hearing, and vision care.
Governance is shared between SHI funds and the national government. Recent reforms delegated some authority to regional health agencies. Central government retains considerable control over the system's overall management (World Health Organization, 2024).
99.9% of the population in France is covered: those who are members of health insurance schemes and those who have free access to state-provided healthcare services (Our World in Data, n.p.)
Public vs private
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The national PHR
History
Mon Espace Santé, a digital platform established by the French government, The "Ma Santé 2022" programme of the French Minister of Solidarity and Health set out a plan in 2019. Point 15 aimed to establish a Digital Health Space to enable citizens to choose and access digital health services securely and easily within the healthcare system. Action 16 focused on providing healthcare professionals with a secure platform for delivering clinical telemedicine services. And Action 8 mandated that all health professionals' software interoperate with the Digital Health Space by July 2023 (Simon and Moulin, 2022).
"Mon Espace Santé” (My Health Space) was the new name in a 2021 decree. The decree specified content and functionality (Simon and Moulin, 2022). The launch on January 1st 2022 represented a milestone in the digitization digitisation of healthcare services . Launched on January 1, 2022, in France. The platform is available for all individuals under the umbrella of Health Insurance, with provisions for opt-outs , the platform has witnessed substantial growth. The realisation of (Simon and Moulin, 2022).
Mon Espace Santé was possible thanks to a collaboration is a partnership between the French government and ; a consortium led by Atos, a player in the field of computer and information technology. This partnership culminated in the creation of the Mon Espace Santé (MES) platform, which was co-developed with CNAM (the ; and the National Health Insurance Fund (CNAM). The project, awarded to Atos at the conclusion of negotiations Atos was awarded the project in November 2020, and the scope of their work included design, development, hosting, operation, and maintenance of Mon Espace Santé. Despite its intricate nature, the timeline for the development of the project was of 13 months, all within a tight 13-month timeframe.
The consortium led by Atos comprises three notable French entities: Maincare Solutions, expert in Identity Management and health directories; Gravitee, an API platform specialist, which contributes to the integration of diverse systems and functionalities.; Beezim which focused on and Beezim, responsible for the platform’s communication features (Atos International, 2022).
Features
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Patients using Mon Espace Santé can view their health data in the record, and can also add their own data to any part of it. The first part of the record is ‘Mon histoire de santé’ (my health history) and shows every interaction the patient had to their health records. The platform's core feature, Mon histoire de santé (My Health History), tracks all patient interactions with the healthcare system, including going visits to the pharmacy, to the GP, etcGPs, specialists, and pharmacies.
Other parts key sections of the record include (Mon Espace Santé, n.p.):
Their conditions
Their treatments and medications
Their hospitalisation and handicaps
Their risk factors, such as allergies, family history, and habits
Their vaccinations
Their health measures: Medical conditions: A summary of diagnoses.
Treatments and medications: Details of current and past treatments.
Hospitalisation and disabilities: Information on inpatient stays and any disabilities.
Risk factors: Documentation of allergies, family medical history, and lifestyle factors.
Vaccinations: Records of immunisations.
Health measures: Metrics like weight, height, BMI, heart rate, and blood pressure…the ‘documents’ section. Here pressure.
Documents: A section where both healthcare professionals and patients can deposit their upload important documents , such as like vaccination certificates. This part also includes test results: patients download the document of the test results (these are not displayed within the record)
Messaging feature: patients and professionals can message each other securely. However, these exchanges can only be initiated by the healthcare team.
Patents Test results are also stored here, although patients must download the test report itself, as it is not displayed directly within the record.
Additionally, a secure messaging feature allows patients and healthcare professionals to communicate. Only the professional can start communication.
Patients can also share a summary of their profile with
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selected healthcare professionals
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Patients can activate ‘My health space’ . For families, Mon Espace Santé allows parents to activate profiles for their children, and their profiles get directly linked automatically linking these to the parent’s parent's records.
Patients can decide who access what. They can go through all the reports and determine who can see them.
https://www.monespacesante.fr/
A carer feature is currently being developed.
The privacy control feature lets a patient review all reports and decide which healthcare providers can access their information.
Challenges and areas for improvement
The platform lacks a feature to view or manage appointments
The platform is still not widely used, as the statistics in the next section show.
Published outcomes - statistics
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Challenges include:
Automatic data integration from hospitals remains inconsistent due to the platform being in its early stages, resulting in patient profiles often displaying only a partial view of their health data.
Some information is not fully structured or coded. For instance, test results are typically provided as PDF files sent by healthcare facilities, rather than being integrated into a structured format within the platform.
As the statistics below indicate, the platform has not yet achieved widespread adoption.
Patients are unable to view or manage appointments directly through the platform.
(PKB interviews, 2024)
Published outcomes - statistics
An article published on 17 February 2023 by Agence du Numérique en Santé highlights the achievements of Mon espace santé in its first year. Since its launch, 65.7 million French citizens—representing over 90% of the insured population— have a profile. Of these, however, only 7.9 million (11.5%) have actively engaged with the platform.
Update
An Article in L'Express from 21 March 2024 reported that:
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11 million French people are using the platform.
From 1 January 2022 to January 2023, over 42.5 million health documents were shared with patients via Mon espace santé, and more than 1.7 million messages have been sent by healthcare professionals to users through the platform (Agence du Numérique en Santé, 2023).
As of 21 March 2024, 11 million patients (16.7%) and 45,000 general practitioners are
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actively using MES (L'Express, 2024).
Screenshots
When a patient clicks to see their medical profile, they get this menu to navigate the record:
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Bibliography
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Agence du Numérique en Santé, 2023. Mon espace santé a 1 an! Available at: https://esante.gouv.fr/actualites/mon-espace-sante-1 (accessed: 18 November 2024).
Atos International, 2022. Atos successfully deploys Mon Espace Santé, France’s online health platform. Yahoo! Finance. Available at: https://finance.yahoo.com/news/atos-successfully-deploys-mon-espace-091000705.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAADikyhlgsw7wl8s3ZW_OBJsmDRWARPuuGjHtoZwUYmM-B7rlV06bwH4tb4dZ9ozlzoIP7V4iT1T3awlB0wY4q1Sgr-_e1JtwlyXO6e39Yb8pm4lf7wRCbQay6q0AIsTW1Ku8_3sYdyC75nrsgjv6chVlk7mhLiA79P6hWJ1c3yiN (accessed: 30 October 2023).
Fischer, A., 2024. "Mon Espace Santé", une action de santé publique bienvenue. L'Express, 21 March. Available at: https://www.lexpress.fr/sciences-sante/mon-espace-sante-une-action-de-sante-publique-bienvenue-par-le-pr-alain-fischer-MALU573CHVAXBJ7AZNRKQVBRSI/ (accessed 20 April 2024).
Mon Espace Santé.
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,n.p.
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Public service to manage your health. Accessed at: https://www.monespacesante.fr/
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(
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accessed: 30 August 2023).
Simon, P. and Moulin, T., 2022. Téléconsultation, télé-expertise, télésurveillance médicale: l’apport de «Mon Espace Santé». Bulletin de l'Académie Nationale de Médecine, 206(5), pp.643-647. Available at: https://www.sciencedirect.com/science/article/pii/S000140792200111X (accessed 3 November 2024).
The Commonwealth Fund, 2020. France: International Health Policy Center. (online) Available at: https://www.commonwealthfund.org/international-health-policy-center/countries/france (accessed 18 July 2024).
World Health Organization, 2024. France: Health System Summary 2024. Health System Summary. 20 May 2024. (online) Available at: https://eurohealthobservatory.who.int/countries/france (accessed 25 July 2024).