For a more efficient health care system.

Summary With a higher level of health expenditure than in many developed countries, France's health performance is quite good, but with particularly marked social inequalities in health. The purpose of this Note is to propose directions for improving the efficiency of the health system as a whole. Three avenues for redesign are proposed. First, contrary to the current logic of limiting Social Security expenditure by reducing reimbursement rates, a "solidarity basket of care" should be defined, which should be accessible to all without financial barriers. This basket would include all health products and curative or preventive procedures, performed in outpatient medicine or in hospitals, which would be covered for clearly identified indications. Its scope would be defined and updated in a systematic and transparent manner on the basis of a ranking of available treatments according to their respective benefits in relation to their costs. Treatments outside this basket would not be covered, even partially, by the community. Second, in order to allocate expenditure according to need and to improve the efficiency of care pathways, the regional health agencies (ARS) should be given a global financial envelope, based on the estimated needs of the populations for which they are responsible. The ARSs would be able to allocate this envelope as best they could between ambulatory medicine, hospitals and the medical-social sector. They would also have control over the agreements and remuneration methods of health professionals. Placing the ARS at the center of the management system would make it possible to better adapt the supply of care to the needs of each region and to optimize resources across all modes of intervention. Third, it is urgent to promote the development of health information systems. A decisive investment is needed to convince the players in the health system, and in particular the insured, to develop the personal medical file. It is indeed crucial that all health professionals produce and share health data, in a secure manner for the patient, in order to coordinate care and limit unnecessary examinations. Public information must also be produced and disseminated on the quality of care provided by hospitals, nursing homes and homes for the dependent elderly (EHPAD) in order to encourage competition in quality and promote equal access to quality care. Finally, comparable indicators on the performance of regions in terms of public health, social inequalities in health and access to care must be produced and widely disseminated. This Note was presented to the Deputy Director of the Prime Minister's Office on Tuesday, July 2, 2013.