The healthcare system accounts for a considerable proportion of the French economy: 12.4% of GDP, with current healthcare expenditure amounting to €284.6 billion in 2020, up 4.6% on 2019. The sector is organised in a highly complex way, as illustrated by a few figures: 3,000 hospitals and clinics with 3 types of status, 8,000 nursing homes, 290,000 self-employed doctors, 600,000 self-employed nurses, 439 entities providing supplementary healthcare in France, etc.

The governance of the healthcare system involves a large number of players at national, regional and local level. Governance can be analysed in two ways :

• On a cross-sectoral level, there is the question of the links between the various components of the healthcare system: healthcare provision, public and private funding bodies, manufacturers, patient representatives and service providers, etc.

• On a vertical level, we focus on the links between the different levels of governance: national, regional and local, with the players involved in healthcare provision.

The governance of the healthcare system is regularly criticised for being too compartmentalised, too centralised, too costly in relation to the results and overall performance of the system, and not agile enough to help it adapt to major changes: chronicity, ageing, pathway-based medicine, therapeutic and digital innovations, etc. At the same time, this governance is subject to regular reforms: the introduction of Regional Health Agencies, Territorial Hospital Groups, Article 51 to encourage innovation in healthcare, etc. At the same time, this governance is subject to ongoing reforms: the establishment of Regional Health Agencies, Territorial Hospital Groups, Article 51 to promote innovation in healthcare, etc. The relationship between compulsory health insurance and supplementary health insurance organisations has also just been examined by the Haut Conseil pour l'Avenir de l'Assurance Maladie (High Council for the Future of Health Insurance). But these developments still seem insufficient, and the health crisis has highlighted weaknesses in the system's governance.

The following issues were discussed with the speakers:

• What are the findings and strengths/weaknesses of healthcare system governance?
• What concrete objectives could be set in terms of improving this governance?
• How should governance evolve, both horizontally and vertically?
• What would be the drivers and levers of this development, and the main obstacles to be overcome?

SPEAKERS :

• Stéphanie Decoopman, Directrice générale adjointe par intérim, APHP
• Aurélien Rousseau, Maître des requêtes au Conseil d’Etat  - Ancien Directeur général, ARS Île-de-France  
• Séverine Salgado, Directrice générale, Mutualité Française

The debate was moderated by Karim Hatem, Senior Partner, Ylios 

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