Country’s healthcare system in a nutshell

The French healthcare system operates under a statutory health insurance (SHI) model, providing universal coverage to all citizens. This system covers a wide range of healthcare services, including hospital care, physician services, long-term care, and prescription drugs. While the SHI covers the majority of healthcare costs, patients are responsible for certain out-of-pocket expenses, such as coinsurance, copayments, and additional charges if fees exceed the covered amounts.

SHI funding primarily comes 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), which helps cover expenses for services like dental, hearing, and vision care.

Governance of the healthcare system is shared between SHI funds and the national government, though recent reforms have delegated some authority to regional health agencies. Despite this decentralisation, the central government retains considerable control over the system's overall management (World Health Organization, 2024).

According to the most recent data from 2011, health insurance covered 99.9% of the population in France. This coverage encompasses both 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

The national PHR

History

In 2019, the French Minister of Solidarity and Health set out a plan for the Digital Health Delegation (DNS) as part of the "Ma Santé 2022" programme. Among the 30 proposed actions, 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, while Action 8 mandated that all health professionals' software be interoperable with the Digital Health Space by July 2023 (Simon and Moulin, 2022).

The decree outlining the implementation conditions for the Digital Health Space was published on 4th August 2021. Following this, the space was renamed "Mon Espace Santé” (My Health Space). The decree outlined its specific content and functionality (Simon and Moulin, 2022).

The launch of Mon Espace Santé on January 1st 2022 represented a milestone in the digitisation of healthcare services in France. The platform is available for all individuals under the umbrella of Health Insurance, with provisions for opt-outs (Simon and Moulin, 2022).

The creation of Mon Espace Santé was made possible through a partnership between the French government and a consortium led by Atos, a major player in computer and information technology. This collaboration, which also involved the National Health Insurance Fund (CNAM), culminated in the development of the MES platform. Atos was awarded the project in November 2020, and the scope of their work included design, development, hosting, operation, and maintenance, all within a tight 13-month timeframe.

The realisation of Mon Espace Santé was possible thanks to a collaboration between the French government and a consortium led by Atos, a player in the field of computer and information technology. This collaboration, which also involved the National Health Insurance Fund (CNAM), culminated in the development of the Mon Espace Santé (MES) platform. The project, awarded to Atos at the conclusion of negotiations in November 2020, included the design, development, hosting, operation, and maintenance of Mon Espace Santé. Despite the complexity of the project, Atos was given a tight 13-month timeframe for its development.

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; and Beezim, responsible for the platform’s communication features (Atos International, 2022).

Features

Patients using Mon Espace Santé can view and add 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 visits to GPs, specialists, and pharmacies.

Other key sections of the record include:

• 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.

• Documents: A section where both healthcare professionals and patients can upload important documents like vaccination certificates. 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, though these conversations can only be initiated by the medical team.

Patients can also share a summary of their profile with selected healthcare professionals. For families, Mon Espace Santé allows parents to activate profiles for their children, automatically linking these to the parent's records.

Another feature is privacy control: patients can review all reports and decide which healthcare providers can access their information.

(Mon Espace Santé, n.p.)

Challenges and areas for improvement

Despite its comprehensive offerings, Mon Espace Santé faces several challenges:

• The platform is still in its early stages, and automatic data integration from hospitals varies widely.

• Even when healthcare systems are connected to Mon Espace Santé, the data are not yet fully structured or coded for optimal use.

• Mon Espace Santé has not yet gained widespread daily use, as the adoption statistics indicate.

• The platform lacks functionality to view or manage appointments directly.

Published outcomes - statistics

According to the latest report from the National Health Insurance Fund (CNAM), Mon Espace Santé has been adopted by 65.7 million policyholders. However, only 7.9 million users—around 11.5%—are actively engaging with the platform.

According to an update from L'Express, as of 21 March 2024, Mon Espace Santé has 11 million active patient users, while 45,000 general practitioners are also utilising the platform.

Screenshots

Once patients click to view their medical profile, they find this menu to navigate the record:

Bibliography

Atos International. (2022) Atos successfully deploys Mon Espace Santé, France’s online health platform. Yahoo! Finance. 23 November. 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. (n.p.). Public service to manage your health. Accessed at: https://www.monespacesante.fr/. (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

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).