Since 2020 there has been a strong growth of telehealth in Europe. Whereas before covid, an average of 2% of European patients used online consultations to contact a doctor, digital services now claim a permanent place in the healthcare system.
‘Thanks’ to the Covid-19 pandemic, several European governments provided or enlarged reimbursement for digital consultations, thus removing the most important barrier for large take-up by doctors.
This was the case in Belgium, but also in Germany, Spain, France and Poland for example.
Telehealth helped to ‘flatten the curve’ and keep the continuity of care. Especially in primary care, being the first point of contact and medical help.
As this temporary telehealth financing in some countries still needs to become permanent and future-proof, the example of France might be very inspirational.
Thanks to its radical choice for accessibility of care, online video consultations and digital=physical care in the financing, France is now at the forefront of telehealth in Europe.
Here’s the story of ‘la French healthcare tech’.
The above timeline shows France started its telehealth journey in 2014 and kept evolving over the past years.
Now, both patients and physicians have easy access and use teleconsultations widely: 19 million video consultations were reimbursed in 2020 and 71% of doctors are familiar with this way of healthcare delivery.
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Why France believes in telehealth
L’Assurance de Maladie, the French Health Insurance organisation, sees telemedicine as a way to improve overall healthcare and to make it more accessible to all French citizens.
The National Health Insurance acknowledges that teleconsultations offer several benefits, such as:
- People living in remote areas get easier access to specialised healthcare professionals
- Treatment and follow-up can be administered faster as waiting times decrease
- Unnecessary visits to the hospital’s emergency departments can be avoided
- Cooperation between different healthcare professionals gets easier. They can ask for each other’s advice and share their expertise. This improves their knowledge and their ability to treat patients
Already in 2018, rules on how to administer a teleconsultation, what to charge for it and how to reimburse it were created during a national medical convention.
4 guiding principles for telehealth since 2018
Principle 1: open to all patients and all health professionals
Telehealth is open and accessible to all patients and all doctors. Everyone can use digital consultation: young and old people, wherever you live, and regardless of your medical history.
All doctors can deliver the service: GP’s as well as specialists, no matter if they work in private practice, a hospital or other medical centre.
The French government and the French High Council of Health (pdf) explicitly choose to make digital consultations accessible for everyone.
This is an important guide for other countries implementing digital health services in their system, since:
- the principle of accessible healthcare to everyone is key in Europe
- patient freedom to choose a health professional is also key within Bismarck systems in Europe
- digital consultations, in general, enhance access to healthcare services, so it is contra-intuitive to make this selective for certain patients and health professionals
Principle 2: the doctor guides to a teleconsultation
Teleconsultations are not meant to replace physical consults.
In some cases, they are not the best answer to a patient’s needs. This decision has to be made by the health professional delivering the teleconsultation service.
Telemedicine in France should be part of a coordinated health plan. Moreover, the patient using the teleconsultation service should be known to the physician who delivers the service.
This means patients ought to have had a physical consultation with the doctor no longer than 12 months ago.
However, exceptions to this principle make it possible for both patient and physician to use teleconsultations more flexible.
The previous patient-doctor relation is not necessary for/when:
- children up to 16 years old
- patients having no permanent personal GP (or GMD)
- highly-wanted specialist doctors
- the regular doctor is unavailable (for example: during weekends or late in the evening)
- circumstances are urgent
Principle 3: teleconsultations are video-based and secured
The teleconsultation is hosted via a secured, video-based platform on a laptop, smartphone or tablet and guarantees the security and privacy of the patient and the healthcare professional.
The platform features a summary of the consultation, a payment service, and an e-prescription service.
Also interesting: French law says an extra health or social professional is allowed to be present to help the patient during the teleconsultation.
Which is useful for elderly people for example. Moreover, patients might be guided to teleconsultation contact points (service centres or pharmacies), to take measurements that support the physician’s diagnosis for example.
Principle 4: digital and physical consultations cost the same
Fees for teleconsultations and physical visits are the same.
The cost lies between € 23 and € 58,50, depending on the type of specialism of the healthcare provider. Patients pay for teleconsultations online, with a cheque or by bank transfer.
The French government refunds 70% of teleconsultation services and up to 100% for people with chronic conditions (part of a coordinated care plan).
More flexibility since the pandemic
The principle of guidance and financing became more flexible in spring 2020:
- patients do not need to see a physical doctor first
- video consultations are possible outside the coordinated care plan
- all digital consultations are reimbursed for 100% , without quantitative limitations
In the first weeks and months of the COVID pandemic, virtual consultations grew up to 5,5 million in France for March and April combined.
Later, as it did in other countries, the number of virtual consultations decreased again.
But the digital practice was so successful that the French health insurance by the end of 2020 advised keeping the flexibility ‘at least until the end of 2022’ as a way to ‘learn and invest in healthcare efficiency and innovation’.
User profiles and opinions on telehealth
Since the start of the general financing of teleconsultations in 2018, usage numbers did steadily increase. We noted an average of 4.000 to 5.000 a week.
And that number peaked at approximately 1 million teleconsultations by the end of March 2020. 11% of all consultations were video consultations in the first weeks and 44% of all GP’s had at least one virtual consultation.
Is telehealth only for the young hipsters?
Telehealth is often said to be a service that doesn’t reach older people.
Criticasters believe that physicians and patients using video consultations are to be found amongst the young hipsters. But is that true?
Data show 27% of all teleconsultations in France are delivered by physicians over 60 years old. This is in line with the representation of this age group within the whole French HCP population.
General practitioners are the champions of teleconsultations in France: approximately 80% of all teleconsultations are administered by them.
Other HCP frequently using virtual consultations are psychiatrists, paediatrics, gynaecologists, dermatologists and endocrinologists.
On the patient’s side, we notice a shift towards older patient groups (pdf) since covid19.
Traditionally, teleconsultations were very popular among urban thirty- and forty-somethings. Since covid, users aged 50 plus grow rapidly, with 20% aged 70 and older (coming from only 8% in 2019).
And during the lockdown, telehealth also became ‘normal’ for people living in smaller cities and villages.
People with chronic diseases count for 23-28% of all teleconsultations.
What do patients and physicians think about telehealth?
Now that telemedicine usage is skyrocketing, it is the ideal time to take a look at the satisfaction rates. The national agency ANS questions citizens and physicians each year.
Early 2021, they interrogated about 3.000 patients and 500 healthcare professionals.
This public barometer on teleconsultations indicates:
- French citizens are getting to know telehealth. And they are convinced it has a positive impact on national health.
- 73% of the national population is in favour of teleconsultations. This is one of the highest rates in Europe.
- Physicians having used teleconsultations once, keep on using it. On average, they administer 91 virtual visits a year.
- French patients give a satisfaction rate of 88%; 8% higher than the average European score.
- Healthcare professionals that have hosted teleconsultations, award it with a satisfaction score of 78%.
- 70% of the French population is willing to book a teleconsultation if their GP or healthcare provider proposes it.
These figures show that the saying ‘The impossible is often the untried’ (J.Goodwin) clearly applies.
La French healthcare tech
So the successful use of telehealth in France was made possible thanks to the large, mature legislation and reimbursement system that existed already when COVID got hold of Europe.
A swift and flexible adoption was possible, both by patients as well as doctors. Because seeds were planted already years before: in public policy, but also in the startup ecosystem.
Thus, it’s not entirely unexpected that Sifted, the European startup-blog of Financial Times, recently speaks of the ‘French tech revolution (pdf)’: France is a frontrunner in telehealth, but also in other tech sectors.
Telehealth regulations in France no doubt are a blessing to the market size and cost-saving opportunities in the country, also indicated by our colleagues of Research2guidance.
And we already talked about the social and cultural impact of it.
But no doubt, they also have a favourable impact on the French healthcare business ecosystem.
Startups and corporates, French as well as international companies: they are building digital health services in ‘la douce France’. And this will also spark startups and ventures in other healthcare segments in France.
Here are 3 of the most important teleconsultation platforms in France:
- Doctolib is one of the three most used digital health tools on the international scene. It offers a fully integrated teleconsultation service equipment to physicians and other HCP, making it possible for them to gain quality of life and comfort too. Worldwide, it has over 35 million users now.
- Livi is the brand of Swedish teleconsultation pioneer KRY in France. It’s on a mission to make care accessible to everyone. Livi hosts more than 3 million consultations in Europe on a yearly basis and is active seven days a week. Both children and adults connect with healthcare professionals in different disciplines through the platform.
- Medaviz is a platform that offers teleconsultation and tele-expertise. Different from Livi and Doctolib, its main entry point is the doctor rather than the individual patient. Medaviz hosts more than 400.000 consultations and connects 9.000 healthcare providers in 50 disciplines, 24 hours each day.
Over 10 teleconsultation platforms are now active in the French market.
Check out some more in our blog ‘visit your doctor online? This is how it’s arranged in France’ from 2019.
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What does the future look like?
1. virtual healthcare = commodity
France wants virtual consultations to become a normal way of providing health services. Video consultations need to become a sustainable option for French patients according to the government.
A mission that looks like it’s going to succeed.
We know that in mature systems like the Nordics and France, teleconsultations can make up 10-15% of all doctor’s visits after 4 years.
2. The proximity aspect
In ‘Ma Santé 2022’, the French government sketches the wish for proximity in future health: all citizens need to have sufficient access to healthcare providers and specialists.
That’s why France started labelling ‘proximity hospitals’. By 2022, the country aims to have 500 to 600 facilities were general medicine, care for the elderly, follow-up and rehabilitation care, speciality consultations and non-medical consultations are provided.
These proximity hospitals must have sufficient telemedicine equipment (pdf). So the deployment of telemedicine and telemonitoring in hospitals will further grow.
3. More investments in digital health
Hospitals and other HC organisations will need to invest more in digital health. France has an open economy and allows large private initiatives to invest in healthcare companies.
Thanks to the rapid current shift towards digital healthcare, telehealth services and healthcare start-ups are seen as interesting businesses to invest in.
Take Doctolib for example the app was launched in 2013 and has raised € 237 million since then. A part of that money was contributed by physicians and healthcare providers who pay to use Doctolib’s services and who may contribute to the further development of the platform in return.
It’s a combination that creates beautiful opportunities for ‘la French healthcare’. So, the future looks bright.
And isn’t this a perspective we all want in Europe?
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