French homecare companies are likely to be able to widen their remit in exchange for lower margins on oxygen, says Thierry Alliotte, head of homecare company Initiative Pour La Sante.

At the moment, Alliotte says there is still an issue as to whether homecare companies are allowed to transport medicines in their pumps. “IPS is licenced for oxygen, but not drugs. If we could carry and deliver these, it would open up the market considerably.” He expects that the oxygen companies will get this wider licence in exchange for agreeing to a fall in the price of oxygen.

Alliotte says that more than 20% of patients do not comply with their medication. The French authorities want to monitor compliance so as to cut costs. “Liberalisation would allow home care companies to help the national insurer Caisse nationale de l'assurance maladie des travailleurs salariés (CNAMTS) to monitor compliance better.” This means education and possibly the telemonitoring of equipment.

Our Analysis: The French state sits between entrenched interests which to an outsider often appear medievael in their complexity. For instance, oxygen homecare companies are not allowed to touch the patient, this is entirely the preserve of a special caste of freelance nurses who have to be self-employed. Alliotte does not expect any change here. Equally, diagnostic laboratories have to be owned by diagnosticians and pharmacies by pharmacists. Imaging is the preserve of radiologists. These guilds cost the French tax payer billions of euros a year. (French diagnostic tests are on average twice the price of German tests and French radiologists earn nearly twice as much as their German counterparts).

Historically, the government has preserved these rights – often braving EU anger to do so. Costs have been controlled by rationing. Radiologists are paid a lot, so it is very hard to get a licence to run an MRI machine.

But it is clear that, recently, the French government is keen to dismantle much of this, as it costs a lot of money and makes it much harder to oversee healthcare delivery. How do you ensure quality in 4,000 tiny labs?

But it is not keen to confront these important groups head on. That is because their members number collectively in the hundreds of thousands or, including the wider medical profession and healthcare staff, millions, and form an important part of the electorate.

The answer seems to be to slowly gnaw away at the guilds. Diagnostic lab prices are reduced systematically year on year and some ownership rules are relaxed a little.  Now it looks as though we will see similar moves in oxygen and the homecare sector.

France may look opaque. Often we are told it is who you know that determines whether you will get a concession or a contract.  But the direction of travel is very clear and favourable to the private sector.

Source : Healthcare Europa 15/11

http://www.healthcareeuropa.com/articles/20101117_5