The Rise of Multi-professional Health Centers in France

Multi-professional health centers (CDS), offering a range of primary care and preventative services, have seen notable growth in France. A recent report by the General Inspectorate of Social Affairs (IGAS) highlights their increasing presence, particularly in underserved communities. While still representing a small fraction (1.2% in 2022) of overall urban healthcare expenditure, these centers have expanded rapidly, experiencing a 65% increase between 2016 and 2022. This growth underscores their potential role in addressing healthcare access challenges, especially considering the even larger presence of MSP health homes, numbering 2,251 in 2022.

Geographic Distribution and Community Focus

These health centers are not evenly distributed across the country. They are primarily concentrated in regions like Île-de-France and hauts-de-France,with a smaller presence in Auvergne-Rhône-Alpes,Grand Est,Corsica,and overseas territories. Notably, a significant portion (around 20%) are located in priority districts designated under city policy, and another 20% in areas adjacent to these priority zones, often referred to as lived districts. This strategic placement indicates a focus on serving populations with specific healthcare needs.

The management of these centers is diverse, with associations (40%), local authorities (23%), social security organizations (18%), and mutuals (7%) playing key roles. Interestingly, very few are managed by public health establishments or commercial entities, accounting for only 8 and 12 active centers respectively in 2022.

Service Offerings and Workforce Composition

Beyond general medicine, manny multi-professional CDS offer specialized services. in 2022, approximately 38% provided dental care, and 24% offered ophthalmological services. The workforce typically includes a mix of healthcare professionals, with an average of six doctors employed per centre, equivalent to 2.6 full-time employees. In 2022, these centers collectively employed around 6,000 doctors and over 1,450 dentists, predominantly on a part-time basis. The number of doctors working in CDS has increased by 24% between 2016 and 2022, reflecting the growing importance of these facilities.

these centers play a crucial role in providing care to vulnerable populations. The average rate of patients with C2S (additional health coverage) and AME (State medical aid) is 18%, significantly higher than the national average of 10%. This highlights their commitment to serving socially disadvantaged communities.

Financial Challenges and Productivity Concerns

Despite their growing importance, multi-professional CDS face significant financial challenges. Operating expenses surged by 78% between 2016 and 2022,driven by rising inflation and a scarcity of medical and paramedical resources. This increase in expenses has not been matched by revenue growth, with fees accounting for 80% of their income.In 2022, revenue growth lagged significantly behind the increase in expenses, leading to a median operating deficit of nearly 10% of expenses, with considerable variations depending on the management structure.

IGAS also notes concerns about doctor productivity within these centers. The median number of active patients per doctor in CDS is 1,481, compared to 1,556 for doctors in private practice. Furthermore, CDS doctors performed a median of 3,396 medical acts in 2022, significantly lower than the 4,616 acts performed by their counterparts in private practice – a difference of 36%. The average number of patients seen per doctor was also lower, at 700 compared to 1,100 in private practice.

Recommendations for a Lasting Future

To address the challenges of medical desertification and ensure access to care,IGAS recommends that health centers increase their active patient base and the number of patients with a designated treating doctor,without compromising the quality of care. The report emphasizes the need to encourage mixed practice models (combining private and salaried work) within CDS and to better reward teamwork. Furthermore, IGAS suggests exploring new pricing models based on capitation, which involves managing the healthcare needs of a defined population.

The economic, financial situation and the current organization of multi -professional health centers do not lead the mission to propose significant changes to the economic model […] Though, the mission is favorable to the emergence of a new financing model, based on a capitation component, for centers whose health professionals are committed, organize and put into practice the sharing of tasks between general practitioners and nurses.

General Inspectorate of Social Affairs (IGAS) Report

The report concludes that while the current economic model may not warrant radical changes,a shift towards a capitation-based financing system could be beneficial for centers that prioritize teamwork and task-sharing among healthcare professionals.