A Perspective from France

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The French Healthcare differs from the UK NHS in that there is a much wider private sector. But the private healthcare sector (and associated insurance model) is highly regulated and in fact embedded with the public healthcare provision; certainly in an economic sense.

When it comes to large scale initiatives, the French government has a complex set of national and regional organisations that make the NHS look positively streamlined. What comes to my mind is the difference between a British Cake shop and a Frenche Patisserie. When you first enter the Patisserie you may be overwhelmed by the choice (and the seemingly mystical rules of what to buy) but you can still find a Custard Slice (aka a Mille Feullie).

Essentially all large scale initiatives are government driven. When it comes to Healthcare Information there are many French Healthcare organisations to keep in mind - but the main directives are issued by the French Ministry of Health and Social Care.

France is suffering the same population health management problems experienced in all western economies at the moment. Namely

France tried to split its Healthcare management into 7 large regions and make 7 large data aggregation projects (sounding awfully familiar to any NPfIT veterans?). This failed due to lack of engagement at a local level. Le plus ca change, plus c'est la meme chose. So instead they opted for a lot (over 300 !) smaller regions called GHTs Groupements Hospitaliers de Territoire.

GHTs make an assumption that care, on a regional basis, is to be coordinated around what we in the UK would call secondary care. Further, that in most regions there will be a natural centre or University Hospital that can act as a hub. In general this is the case.

Collectively they work together (under the plus or minus accepted) guidance of the central organisation to

Overall the aim is to service a large population with a smaller number of specialist healthcare workers.

Much more can be written on this - including the interplay of the many regional and academic organisations. But some interesting things can be seen: standards to play a role. Out of our big three standards

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