The Case for an Integrated French Health System

More than two years of Covid pandemic have greatly tested the health systems of most countries in the world. Though health-sector personnel in France withstood that test, they did so at a cost of physical and moral exhaustion and they have called regularly for the system to be remodelled. On the local scale, the shortage of practitioners and the development of ‘medical deserts’ are regularly mentioned as being among citizens’ main concerns. There is no doubt that the reform of the French health system should have a prominent place among the issues of the five-year presidential term that has just begun. To help fuel thinking on this subject, this article by Philippe El Saïr, Émilie Lebée-Thomas and Antoine Malone proposes a new pathway that consists in establishing an integrated system optimizing the supply of care and the expenses incurred at specific territorial levels. The authors, all of them high-level hospital practitioners, base their proposal on a mode of cooperation that is already being trialled in five French areas, which draws on exercises already under way in other countries. There are four objectives at the heart of the project: better patient care, better health among the target population; better use of budgetary resources; and, lastly, better working conditions for healthcare personnel. The authors first remind us what is meant by the notion of integrated health care and outline the models that have already proved effective either vertically (Kaiser Permanente in California, the National Health Service in Britain) or horizontally (Gesundes Kinzigtal in Germany, Accountable Care Organizations in the USA, Intégreo in Belgium), before showing how such integration could be achieved within the French health system. Building on these pioneering experiments, they specify the optimal territorial scale, the obstacles to be overcome and the assets to be mobilized, as well as the necessary prerequisites for the roll-out of an integrated model at the national level.