{"id":12632,"date":"2021-12-12T07:30:47","date_gmt":"2021-12-12T05:30:47","guid":{"rendered":"https:\/\/www.sciencespo.fr\/research\/cogito\/home\/medecine-de-ville-une-liberte-de-plus-en-plus-encadree\/"},"modified":"2021-12-15T10:10:53","modified_gmt":"2021-12-15T08:10:53","slug":"ambulatory-medical-care-in-france-an-increasingly-framed-freedom","status":"publish","type":"post","link":"https:\/\/www.sciencespo.fr\/research\/cogito\/home\/ambulatory-medical-care-in-france-an-increasingly-framed-freedom\/?lang=en","title":{"rendered":"Ambulatory Medical Care in France"},"content":{"rendered":"

An Increasingly Constrained Autonomy for Private Healthcare Professionals<\/span><\/h3>\n

Par Anne Moyal, Centre de sociologie des organisations et LIEPP<\/p>\n

In February 2019, while visiting a multi-professional health care center (Maison de Sant\u00e9 Pluriprofessionnelle<\/i> – MSP) in France, the then-Prime Minister \u00c9douard Philippe declared, “This initiative here, and others in France, show the way. And the objective of the new <\/i>bi<\/i>ll<\/i> is to ensure that these initiatives can be reproduced throughout the country, so that the collective practice of medical care becomes the norm\u201d. <\/i>He was careful to specify, however, that this model of practice would not be “mandatory”, <\/i>and anxious not to call into question the autonomy and freedom of organisation of private health care professionals in the ambulatory sector.<\/p>\n

MSPs are ambulatory health care structures that bring together private professionals, mainly general practitioners (GPs) and paramedics (nurses, physiotherapists, chiropodists, speech therapists, etc.), and offer coordinated primary care – from prevention to acute care, including therapeutic education. Introduced in the French law in 2007, they have been consistently promoted by successive governments as a response to the health care system\u2019s main demographic, epidemiological, organizational, and financial challenges. Although they have grown in number from around 20 in 2008 to almost 1,900 in 2021, they are struggling to convince private health care professionals: to date, only around 20% have chosen this model of practice.<\/p>\n

How does the French government try to regulate primary care practice? How do private health care professionals react and what role do they play in this regulatory process? What does the public policy supporting MSPs tell us about the deeper transformations of the French health care system?<\/p>\n

\u200b\u200bA Tension Between Regulatory and Liberal Logics<\/h4>\n

Philippe’s public statement clearly reflects the central tension in the French health care system between a liberal logic based on the autonomy of ambulatory health care practitioners \u2013 who are mainly private professionals – and a regulatory logic through which the State seeks to organise a sector hitherto left in the hands of the medical profession.<\/p>\n

Since the beginning of the 2000s, several reforms have been undertaken to organise ambulatory care in response to new structural challenges: population ageing; increase of chronic diseases; medical care supply shortage and difficulties of access to medical care in certain territories; insufficient coordination between ambulatory health care professionals but also between ambulatory and hospital sectors; under-developed public health and especially prevention…<\/p>\n

\"\"MSPs are a key measure of the renewal of health policies in France: these new organisations are presented in several public reports(1)<\/sup><\/a>Bernier Marc, 2008, \u00ab Rapport de la commission \u201cAffaires culturelles, familiales et sociales<\/a>\u201d\u00a0\u00bb,\u00a0 Assembl\u00e9e nationale\u00a0; HCAAM, 2007, \u00ab\u00a0Rapport du Haut conseil pour l\u2019Avenir de l\u2019Assurance Maladie pour 2007<\/a>\u00a0\u00bb\u00a0; Juilhard Jean-Marc, 2007, \u00ab\u00a0Offre de soins\u202f: Comment r\u00e9duire la fracture territoriale\u202f? – Synth\u00e8se du rapport\u00a0<\/a>\u00bb, S\u00e9nat, Commission des affaires sociales.<\/span><\/span>