France
- Federica Andreoni
Country’s healthcare system in a nutshell
The French healthcare system operates on a statutory health insurance (SHI) model, ensuring universal coverage for its citizens. This system covers most hospital, physician, and long-term care costs, as well as prescription drugs, with patients paying for coinsurance, copayments, and balance bills for charges exceeding covered fees. The SHI is mainly funded by payroll taxes from employers and employees, a national income tax, and specific industry and product levies. Ninety-five percent of citizens have additional voluntary complementary private health insurance (VHI) to cover out-of-pocket expenses and dental, hearing, and vision care.
The SHI funds and the national government are the principal entities overseeing the French healthcare system. Although recent reforms have decentralised some authority to regional health agencies, the central government maintains significant control over governance (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 pink column refers to the public expenditure as a % of the country’s total healthcare expenditure. The blue dot is the country’s expenditure on health per capita, expressed in international dollars at purchasing power parity.
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 allowing citizens to choose and access digital health services securely and easily within the healthcare system. Action 16 aimed to provide healthcare professionals with a platform for communicating service packages to facilitate clinical telemedicine securely and efficiently, while action 8 requested the software used by all health professionals to 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) with its specific content defined in the decree (Simon and Moulin, 2022).
The launch of Mon Espace Santé on January 1st 2022 represented a milestone in the digitization 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 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 partnership culminated in the creation of the Mon Espace Santé (MES) platform, which was co-developed with CNAM (the National Health Insurance Fund). The project, awarded to Atos at the conclusion of negotiations in November 2020, 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.
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 the platform’s communication features (Atos International, 2022).
Features
Patients 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 with the healthcare system, including going to the pharmacy, to the GP, etc.
Other parts of the record include:
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: weight, height, BMI, heart rate, blood pressure…
the ‘documents’ section. Here both healthcare professionals and patients can deposit their important documents, such as 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 can also share a summary of their profile with the healthcare professionals of their choice.
Patients can activate ‘My health space’ for their children, and their profiles get directly linked to the parent’s records.
Patients can decide who access what. They can go through all the reports and determine who can see them.
(Mon Espace Santé, n.p.)
Challenges and areas for improvement
The platform is still at its early stages so the degree to which data get added automatically from an hospital system to a patient’s record vary.
Of those hospitals/GP systems which are integrated with Mon Espace Santé, the data that flow to the platform are not structured nor coded.
The platform is still not widely used, as the statistics in the next section show.
The platform lacks a feature to view or manage appointments
Published outcomes - statistics
As of the latest report by the National Health Insurance Fund (CNAM), 65.7 million policyholders have embraced this digital frontier, signifying its widespread adoption among the French populace. However, it is noteworthy that only 7.9 million users, equivalent to 11.5%, have actively engaged with the platform.
Update
An Article in L'Express from 21 March 2024 reported that:
11 million French people are using the platform.
45,000 general practitioners are also using the platform.
Screenshots
Once patients click to view their medical profile, they find this menu to navigate the record:
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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: (Accessed 18 July 2024)
World Health Organization, 2024. France: Health System Summary 2024. Health System Summary. 20 May 2024. [online] Available at: [Accessed 25 July 2024].