France

Owned by Federica Andreoni
Last updated: Nov 18, 2024
7 min read

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’s universal coverage operates under a statutory health insurance (SHI) 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

Health care spending by country in 2021 (2).svg
Source: The World Bank.
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

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 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).

Mon Espace Santé is a partnership between the French government; a consortium led by Atos; and the National Health Insurance Fund (CNAM). 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 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

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Ameli.fr

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 (Mon Espace Santé, n.p.):

  • 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. Only the professional can start communication.

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.

The privacy control feature lets a patient review all reports and decide which healthcare providers can access their information.

Challenges and areas for improvement

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.

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 actively using MES (L'Express, 2024).

Screenshots

 

Login screen

 

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The Home page’s buttons show patients their medical profile and upload health documents. The page also links to booked vaccinations and current treatments.

When a patient clicks to see their medical profile, they get this menu to navigate the record:

Within ‘Suivi médical’, there are various subtabs:
- Patient’s conditions;
- Treatments;
- Hospitalisations;
- Handicaps.

 

Within 'Facteurs de risque', Risk factors, there are these subtabs:
- Allergies.
- Family history.
- Habits.
In the menu, patients can also access important sections including vaccinations, measurements, healthcare professionals, and wills. The Wills section contains written wishes regarding the conditions for continuing, limiting, stopping, or refusing treatment or medical procedures in situations where the patient is unable to communicate, particularly in end-of-life scenarios.
Within ‘Suivi médical’, there are various subtabs:
- Patient’s conditions;
- Treatments;
- Hospitalisations;
- Handicaps.

 

Within 'Facteurs de risque', Risk factors, there are these subtabs:
- Allergies.
- Family history.
- Habits.
In the menu, patients can also access important sections including vaccinations, measurements, healthcare professionals, and wills. The Wills section contains written wishes regarding the conditions for continuing, limiting, stopping, or refusing treatment or medical procedures in situations where the patient is unable to communicate, particularly in end-of-life scenarios.

 

 

When patients click to select recipients for messages, they can only pick professionals who have previously communicated with them. However, patients can initiate an exchange with pharmacies.

 

The My Medical History section provides an overview of the patient’s healthcare journey. This includes records of consultations with healthcare professionals and any interaction with healthcare providers. Patients can click on an event to see more information about it

 

When patients click on the event from the previous screen, they can view detailed information about their transactions. In this case, the event was the patient buying a prescribed medication. This detailed view includes specifics about the medication purchased, the pharmacy where the transaction took place, and the type of doctor who prescribed it - in this instance a general practitioner.

 

Patients can add a condition to their record by typing its name directly into the designated field. They are also required to specify the date the condition first appeared and can include any supplementary information that may be relevant.

 

In the Medications section, patients can view information about the medications they are currently taking. They also have the option to add a new medication.

 

In the Health Documents section, patients can access important documents, including PDFs of test results (which are not coded within the platform) and COVID vaccine certificates, among others. While some healthcare providers automatically upload information to this section, this is not always guaranteed, as the platform is still relatively new.
When patients open the test results in the Documents section, they are presented with a PDF view of their results.

 

In the Measurements section, there is a dedicated tab for each type of measurement. Patients have the option to add these measurements manually or have them recorded by healthcare professionals. Currently, there are no integrations available with hospital systems or devices, and the data is not coded or structured. This section includes various measurements, such as weight, height and more (see below screenshot).
Other measurements incluse body mass index, waist size, heart rate, blood pressure, blood glucose, and haemoglobin A1C (HbA1C).

Bibliography

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