Table of Contents

Executive Summary

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TABLE OF CONTENTS

EXECUTIVE SUMMARY

INTRODUCTION

Definitions

Methodology

The French Economy

Exchange Rates

Abbreviations

Regions of France

HOSPITAL FINANCING

Funding Sources

Overview

Social Security

Households

Mutual Benefit Societies

Insurance Companies

Hospital Financing

Public Hospitals

Private Hospitals

MARKET SIZE

Market Size and Trends, 1994-1998

Market Segmentation, 1994-1998

Overview

Public Sector

Private Sector

Factors Affecting Demand

Overview

Government Policy

General Economic Environment

Social Trends

Demographic Trends

General Health of the Population

Innovation in Medical Treatment and Techniques

Forecast Market Size, 1999-2003

Forecast Market Segmentation, 1999-2003

REGIONAL TRENDS

OPPORTUNITIES FOR SUPPLIERS

Overview

Purchasing Procedures

Public Sector

Private Sector

Purchase Criteria

INDUSTRY STRUCTURE

Overview

Hospitals

Assistance Publique - H"pitaux de Paris

CHRU de Lille

Compagnie G‚n‚rale de Sant‚

Groupe Clininvest Auxigem

Le Club des Quinze

TRADE ASSOCIATIONS

TRADE MAGAZINES

List of Tables

1 French Economic Indicators, 1992-1998

2 Funding Of Public Hospitals In France, By Funding Source, 1998

3 Funding Of Private Hospitals In France, By Funding Source, 1998

4 French Hospital Expenditure, 1994-1998

5 Number Of Hospitals And Beds In France, 1994-1998

6 French Hospital Expenditure, By Sector, 1994-1998

7 Number Of Hospitals In France, By Sector, 1994-1998

8 French Public Hospital Expenditure, 1994-1998

9 French Public Hospital Expenditure, By Type Of Hospital, 1994-1998

10 Number Of Hospitals And Beds In The Public Sector In France, 1994-1998

11 Number Of Beds In French Public Hospitals, By Type Of Care, 1994-1998

12 Number Of Beds In Public Hospitals In France, By Type Of Hospital And Type Of Care, 1998

13 French Private Hospital Expenditure, 1994-1998

14 French Private Hospital Expenditure, By Sector, 1994-1998

15 Number Of Hospitals And Beds In The Private Sector In France, 1994-1998

16 Number Of Beds In French Private Hospitals, By Type Of Care, 1994-1998

17 Number Of Beds In Private Hospitals In France, By Type Of Establishment And By Type Of Care, 1998

18 Population In France, By Age Group, 1993-1997

19 Life Expectancy Of Men And Women In France, 1950-2050

20 Main Hospitalisation Causes In France, 1993

21 Forecast French Hospital Expenditure, 1999-2003

22 Forecast Number Of Hospitals And Beds In France, 1999-2003

23 Forecast Hospital Expenditure In France, By Sector, 1999-2003

24 Forecast Number Of Hospitals In France, By Sector, 1999-2003

25 Number Of Beds In French Hospitals, By Sector And By Region, 1998

26 Technical Medical Facilities In France, By Type Of Equipment, 1994-1996

27 Bed Portfolio Of Assistance Publique - H"pitaux de Paris, By Type Of Care, 1993-1997

28 Major Equipment Of Assistance Public - H"pitaux de Paris, By Type Of Equipment, 1997

29 Notified Investment Of Assistance Publique - H"pitaux de Paris, 1993-1997

List of Diagrams

1 The Structure Of The French Hospital System, 1998

2 The Structure Of French Health Care Funding, 1998

3 Administrative Channel For Establishing Hospitals' Annual Budgets, 1988

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EXECUTIVE SUMMARY

MSI believe that hospital expenditure in France accounted for 47 percent of the total healthcare spending in France in 1998. Hospital expenditure in France is estimated to have increased between 1994 and 1998 to reach a value of FF346.5 billion (ECU52.3 billion) in 1998. However, the rate of growth of the French hospital market followed a declining trend toward the end of the review period. This downward trend largely reflected the rationalisation and restructuring policies undertaken by the government in order to limit government spending.

Recent reforms of the hospital sector are believed to have led to a decline in the number of hospitals. Indeed, the strengthening of the regulations affecting the hospital sector has led to mergers and closures of hospitals. The number of hospitals in France is estimated at 3651 hospitals and the number of beds at some 499 900 in 1998. Private hospitals accounted for the largest share of the total number of hospitals with a share of some 71 percent in 1998.

MSI believe that the main factors that affect the French hospital sector include the following:

- government policy

- general economic environment

- social trends

- demographic trends

- general health of the population

Government restrictions on healthcare expenditure will lead to a number of new developments:

- the creation of hospital agencies whose role includes deciding on medical equipment allocations and operational funding

- hospital services will be quality assessed according to national standards

- the development of co-operation and resource sharing between hospitals

- some regional disparities in the level of care and funding will be addressed

Another consequences of the government's reforms is that the different categories of public and private hospitals have been increasingly specialising in the supply of one type of care.

MSI forecast that French spending on hospitals will decline in real terms between 1999 and 2003. Nevertheless, the rate of decline of the hospital market is expected to decrease during the forecast period. Similarly, after a significant decline of 5 percent in 1999, the number of hospitals in France is forecast to decline at more moderate rates during the remainder of the forecast period. The number of hospitals in France is expected to amount to 3302 hospitals in 2003.

MSI believe that the number of private hospitals will decline more rapidly than the number of public hospitals between 1999 and 2003. Indeed, the combination of government reforms with increasingly competitive pressures within the private sector is expected to continue stimulating the number of acquisitions, leading to the emergence of larger private hospital groups and closures of small private hospitals.

The Ile-de-France region around Paris accounted for some 16 percent of public hospital beds and an estimated 18 percent of private hospital beds in 1998 and, as such the Ile-de-France region accounted for the largest proportion of hospital beds in France. During the same year the Provence-Alpes-Cote d'Azur region represented the second largest concentration of private hospital beds with some 13 percent of the number of private hospital beds, while the Rhone-Alpes region was the second largest concentration of public hospital beds with some 10 percent of all public hospital beds in 1998.

Despite the recent measures launched by the government aimed at restricting healthcare spending in the long term, the rationalisation and restructuring process of hospital services in France has led to a number of projects to build new modern hospital units which are designed to replace smaller outdated facilities. A key example of such projects is the construction the George Pompidou European hospital by the Assistance Publique d'Hopitaux de Paris, in the Parisian region. The government's reform programme for the hospital sector also led to the forming of groups between public as well as private hospitals, increasing the concentration of capital expenditure for the purchase of high tech medical equipment.

Text © 1999 MSI

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