Editor’s note: This is the third in a series of posts this week from the Nashville Health Care Council’s International Health Care Mission to Paris. To view others, click here.
What better way to understand the health system in France than to visit a hospital? Today, our group of Nashville Health Care Council members divided up to tour a private not-for-profit hospital, a private for-profit hospital and a public hospital in Paris. On our tours, we found trends and challenges similar to those at American hospitals, including more hospital-employed physicians, increased employee recruitment needs and static reimbursement levels.
American Hospital of Paris
The 144-bed American Hospital of Paris, a private, not-for-profit hospital, finds expansion of services difficult for two reasons: 1) The high cost of land in Paris makes physical expansion difficult and 2) The government limits the services private hospitals can offer. To help overcome this, AHP markets to foreign patients, who now account for 40 percent of its revenue.
The hospital, pictured here in a Wikipedia photo, has 782 employees and 376 doctors. As a not-for-profit, it must charge its patients, who then are reimbursed by social security and, if they have it, their private insurance. AHP also solicits private donations to offset operational costs.
The hospital’s history is worth a note. It was founded in 1904 by an American doctor and a French doctor in part to treat the many Americans living here at the time. It was used to treat American soldiers in World War I and during the German occupation in World War II, an American doctor used it to shelter British, Canadian and U.S. airmen who had been shot down over France. Its mission is to provide the best of American and French care.
Clinique de l’Alma
The Clinique de l’Alma, a 60-bed private, for-profit hospital also relies on foreign patients for revenue. A nephrologist and his family own 75 percent and an investment fund owns 25 percent. The hospital’s primary services are dialysis, urology, orthopedics, gynecology and gastroenterology. It has 150 employees and 60 doctors.
Hospital leaders at de l’Alma identified a mix of operational and health practices among their challenges. As in the U.S., more hospitals in France are directly employing physicians. Many physicians here prefer the steady income of hospital employment. But the government only allows public hospitals to do so, putting the private hospitals at a disadvantage when it comes to recruiting medical staff. Officials also cited general human resources issues resulting from difficulty in finding qualified employees and strict hiring and firing laws.
France has seen an increase of two to three percent in renal disease due to aging and an increase in diabetes related to obesity. Interestingly, a drop in the availability of kidneys for transplants because of fewer traffic accidents also has driven the rise in demand for dialysis.
Hospital Saint Louis
Hospital Saint Louis, the public hospital our group visited, is part of Paris’ 37-hospital system. Saint Louis has 563 beds and 3,200 employees, which includes 700 doctors. As part of the tour, our group visited its dermatology museum, the site of the first school of dermatology built in 1800. Dermatology is still offered there along with a variety of services including hematology, oncology, plastic surgery, transplants and burn treatment.
The hospital collaborates with the others in the Paris system. As noted earlier, it also has the option of directly employing its own physicians but it shares the same challenges recruiting nurses and other employees. And as with the private hospitals, Saint Louis and the other 36 hospitals in the city’s system operate at a deficit.
It does have one marketing advantage. It has developed a state-of-the-art laboratory that cuts the time to process tests by as much as 50 percent. As a result, it is now working to win lab work from private and public hospitals throughout the country.
Again, we end the day reflecting on the similarities between the challenges and opportunities France faces with those we have at home.