Health Care Provision

Health care institutions

Health care institutions include hospitals (public or private) participating in the public hospital service, and for-profit private clinics. France has about 3,000 health care establishments, about a third of which are public and the remainder, private.
As specified by the Public Health Code, France’s public hospitals are legally autonomous and manage their own budget. Their activities are neither industrial nor commercial and they may be municipal, departmental, interdepartmental or national in status.

There are several categories of hospital:
- 31 regional hospitals (CHR, centres hospitaliers régionaux), 29 of which are also teaching hospitals (CHRU, centres hospitaliers universitaires),
- 562 general hospitals (centres hospitaliers généraux),
- 349 local hospitals, located in small towns and rural areas.

There are also a small number of national hospitals such as the Quinze-Vingts and National Hospital of Saint-Maurice.
France also has a health service for military personnel, operating under the supervision of the Ministry of Defence and governed by special provisions.
The main remit of this body is to provide support to the armed forces, both in France and abroad.

The various establishments participating in the public hospital service must fulfil certain obligations in terms of continuity of care and equal access to health care. They provide acute, follow-up, preventive and palliative care.
In particular, the public hospital service participates in:
- graduate and post-graduate teaching,
- research in the medical, pharmaceutical and dental health fields,
- continuing training of practitioners and training of midwives and paramedical staff,
- preventive medecine and health education programmes,
- provision of emergency care.

Private health care institutions include non-profit establishments - usually participating in the public hospital service (the Red Cross hospitals for example) – and for-profit establishments (private clinics).

For many years financed by a system of per diem rates, then a system of global budgets, public hospitals will henceforth be funded through diagnosis-related payments (similar to the US DRG system), which are progressively being put in place. Private clinics, which are currently remunerated on a per diem and fee-for-service basis, will be required to adopt a similar mechanism, with a view to aligning public and private-sector funding mechanisms.