The French healthcare system “L'Assurance Maladie” is modelled on national health insurance (NHI) that has evolved with changing policies.
The NHI system encompasses multiple facility types including private practices for non-hospital care, healthcare facilities for hospital-based care, and residential facilities for vulnerable customers .
Since the integration of NHI, the French hospital landscape has evolved, with the number and type of hospitals changing over time. With this reorganisation, hospitals have driven improvements in delivery of patient care.
However, this creates challenges in the distribution of commercial medical devices to France, as the medical device industry is mostly comprised of niche-market producers.
In this month’s blog, IDR Medical explore the French hospital landscape, structure of the French healthcare system and future plans for development to aid in understanding the market for successful distribution of medical devices (For information on the US hospital landscape, please visit our dedicated blog).
The French hospital landscape is built on the foundation of NHI. Care organisations that spring from this include the following:
Each of these sectors are integrated into a network that is ultimately run by ministries at a national level:
Figure 1: The structure of the French hospital system. The organisation is outlined by a network of interacting local bodies that report to ministries at a national level.
The number of hospital beds in France, between years 2013-2020, has gradually decreased (Figure 2) . According to a report by the French Ministry of Health, the COVID-19 pandemic has exacerbated this decrease in available hospital beds:
Figure 2: The change in number of French hospital beds between years 2013-2020. The number is shown to be gradually decreasing. Adapted from .
To prevent the spread of infection of COVID-19, many double hospital rooms were converted into single rooms, and hospitals underwent deprogramming to reassign nursing staff from general wards to intensive care units.
Hospitals in France can be public, private non-profit or for-profit. Patients are able to choose their hospital and receive approximately the same social insurance coverage.
There are four levels of public hospitals:
Community level structures offering acute care, follow-up care and rehabilitation, and long-term care. Most doctors that work in local hospitals are self-employed private practitioners.
The most common type of public hospital. They provide a range of acute care services, rehabilitation, long-term care and may also provide psychiatric care.
Provide a higher level of specialisation and technical capacity; many of which are linked to a university and operate as teaching and research hospitals.
Including psychiatric hospitals.
Figure 3: The percentage frequency of types of French public hospitals. Most public hospitals provide general care with a range of services. Adapted from .
Public hospitals represent approximately one third of hospitals . Private hospitals, however, fall into either non-profit or for-profit categories and are often more specialised with private non-profit hospitals, accounting for approximately 30% of all private hospitals.
The distribution and frequency of types of French hospitals needs to be understood to successfully supply commercial medical devices to France.
In 2019, the French medical device market was estimated to have a turnover of over €31 billion. The market turnover for exports was estimated at €8.9 billion, accounting for 26% of the market. US medical market enterprises alone bring in over 20% of the total turnover and this figure is expected to grow over coming years .
Within the market, sectors including orthopaedics, non-invasive surgery and disposable medical equipment have proven to have the best prospects. New medical technology is expected to bring rapid developments to the French healthcare system, as shown by the steady growth of innovative medical procedures in France.
Although these changes can have a positive impact on the delivery of patient care, they may create challenges for medical device manufacturers through the requirement of greater negotiating power and price procurement.
In this way, the generation of highly innovative ideas in medical equipment are thought to be the gateway to entering this field of niche market providers.
Leading sub-sectors within the medical device market of France include diagnosis, rehabilitation, surgery, technical aids, intensive care, and hygiene as outlined in Figure 4:
Figure 4: The percentage frequency of leading sub-sectors of medical devices. Most medical device marketing is within the field of diagnosis.
Despite the success of the current French healthcare system, it also faces many challenges. The rise of health expenditures leads to budget deficits, and with the number of doctors expected to significantly decrease in the near future, a new public health framework is required.
The ‘new hospital governance’ gives more flexibility and relative internal organisational freedom to public hospitals, allowing more flexibility in hospital management .
A strategic plan has been outlined, with plans to conclude it by year 2023:
Build, strengthen and maintain state parties’ core capacities required under the IHR (International Health Regulations) (2005).
Strengthen event notifications and management in compliance with the requirements under the IHR (2005).
Measure progress and promote accountability.
Figure 5: The ‘three strategic pillars’ to strengthen and maintain adequate capacities in the European Region. Three strategic stages to effectively prevent, prepare for, detect, and respond to public health threats and to aid affected countries, when necessary.
Therefore, engaging with these stakeholders and understanding their decision-making processes will become even more essential for ensuring product success. Conducting market research allows medical device manufacturers to understand the priorities of health systems and their product/service needs.
IDR Medical recognises the need to ensure your medical technology demonstrates value to clinical advocates, administrative stakeholders, and payers.
As experts in medical market research, we can help your firm demonstrate the added value of your innovative solutions to ensure adoption and reimbursement.
If you would like an initial telephone discussion, or a face-to-face meeting to understand how we can help your device take market share, please contact us today.
 Wagner.nyu.edu. 2021. [online] Available at <https://wagner.nyu.edu/files/faculty/publications/French.health.system.03.2018%20%281%29.pdf> [Accessed 28 September 2021].
 Trading Economics. 2022. France Hospital Beds. [online] Available at: <https://tradingeconomics.com/france/hospital-beds> [Accessed 08 February 2022].
 Sandier S, Paris V, Polton D. 2004. “Health Care Systems in Transition: France” (PDF). World Health Organisation Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.
 Privacyshield.gov. 2021. France - Medical Devices (MED) | Privacy Shield. [online] Available at: <https://www.privacyshield.gov/article?id=France-Medical-Devices> [Accessed 28 September 2021].
 Euro.who.int. 2021. [online] Available at: <https://www.euro.who.int/__data/assets/pdf_file/0009/393705/Action-Plan_EN_WHO_web_2.pdf> [Accessed 28 September 2021].