Update on teleconsultations in France (2021) >

Update on telehealth app Doktr in Belgium (2021) >

At first sight, patients having teleconsultations with a GP or another health professional should be obvious in 2019.

But make no mistake.

Online consultations are becoming commonplace in the USA, Latin America and Asia already for some years now. But up till now, only a few European countries reimburse teleconsultations, thus making it a ‘normal’ health service. Fear of cost explosion and difficulties to decide upon modern refunding principles are paralysing decision makers.

But France might be at the forefront. The 3 rd biggest economy in Europe started teleconsultation reimbursement as from 15 September 2018 and does so in a remarkably straightforward way.

Let’s take a look at how digital consultations are organised in ‘la douce France’.

Definition of telemedicine and teleconsultations

A teleconsultation is a contact between a health professional and a patient using information and communication technology. France recognises 5 types of telemedicine:

• teleconsultations
• tele-expertise
• medical telesurveillance
• medical tele-assistance
• medical answer

All forms have the possibility to make a diagnosis, ensure a preventive visit or a follow-up visit, to prescribe or carry out services or to monitor the condition of patients. 

Teleconsultations in France are organised and reimbursed according to 4 principles.

Principle 1: open to all patients and all health professionals

It includes all patients and all doctors. All patients have access to teleconsultations: young and old people, wherever you live, and no matter what’s your medical history. All doctors can deliver the service: GP’s as well as specialists, no matter if they work in a private practice, a hospital or another centre.

The French government and the French High Council of Health 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 their health professional is also key within Bismarck systems in Europe
• digital consultations, in general, enhance access to health care 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 patients needs. This decision has to be made by the health professional delivering the teleconsultation service or the teleconsultation doctor.

Telemedicine in France should be part of a coordinated health plan. Moreover, the patient using the teleconsultation service should be known to the doctor 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 doctor to have a more flexible use of teleconsultations in France.

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 (eg during weekends or late in the evening)   
• circumstances are urgent

Principle 3: teleconsultations are video-based and secured

• The teleconsultation works via a secured, video-based platform on laptop, smartphone or tablet and guarantees security and privacy of the patient and doctor. The platform features a summary of the consultation, a pay service, and e-prescription service.  
• Also interesting: French law provides the possibility for a health and social professional to be present to help the patient during teleconsultation. Which is useful for elderly people for example. Moreover, patients might be guided to teleconsultation contact points (service centres or pharmacies), eg to take measurements that support doctors diagnosis.    

Principle 4: digital and physical consultations cost the same

A GP teleconsultation in France costs 25 euro, as does a physical doctors visit. A specialist teleconsultation costs about 3O euro, depending on the type of specialism. Patients pay for teleconsultations online or by bank transfer.

Government refunds 70% of teleconsultation service and up to 100% for people with chronical conditions.  

The French government has set a budget for 500k teleconsultations in 2019, 1 million in 2020 and 1,3 million in 2021. This way, fear of cost explosion is managed.

What do we know after 6 months?

At the launch of teleconsultations reimbursement, about 30% of French doctors were a priori positive about the service. Nevertheless, 73% of French doctors said they think teleconsultations will be part of their day to day work in 2030. So it might take some time before the full force of doctors is reached.

By the end of March, after 6 months, almost 8000 teleconsultations were reimbursed, according to Europe1.

Over 10 teleconsultation platforms are now active in the French market, from startups to corporates-French as well as international companies. It is clear telemedicine reimbursement makes scalable business models possible to many.

Here are some of them:

• Medicitus: doctors consult in a pharmacy. Speak a doctor in 5 minutes.
• Qare: find your health professional for online consultation, hold a teleconsultation and get reimbursement.
• Eutelmed: speak to a health professional in your own language. Care for people living abroad. Also with an offer for employees.
• Doudoucare (pediatric teleconsultation) and doctoconsult (psychiatric teleconsultation)   
• Livi: teleconsultation service from Swedish innovator KRY, on a mission to make care accessible to everyone ‘at your fingertips’.
• Docavenue:  the teleconsultation offer of ICT company Cegedim 
• and recently also French largest doctor’s visit scheduling company Doctolib has started a teleconsultation offer. For 79 euros a month, doctors can have fully integrated teleconsultation service equipment, making it possible for them to gain quality of life and comfort too.

It looks like telemedicine reimbursement in France opens up possibilities for patients, health professionals, government as well as HealthTech entrepreneurs. They include comfort, health education, new ways of working, data on health care quality, and new health business ecosystems.

Update on teleconsultations in France (2021) >

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