Health technology assessment in France

The French healthcare system combines freedom of medical practice with nati onwide social security. It is compulsory for every legal resident. A range of public and private institutions provide care, and patients have free acc ess to physicians. The hearth coverage system is characterized by solidarit y and universal responsibility. Although the French system is highly regula ted, funding of health-related expenses is a chronic social problem. Since the 1996 healthcare reform. the national objective for reimbursed healthcar e expenditures is voted by the parliament, and the annual increase of hospi tal funding is controlled at the regional level. An agency for hospitals ha s been established in every region, and it quantifies needs indexes for fut ure equipment and beds. However, establishing appropriate reference ratios based on objective assessment is difficult. The idea of basing policy and p ractice decisions on objective assessment grew for years, until the Nationa l Agency for the Development of Medical Evaluation was established in 1989. The 1996 healthcare reform expanded this agency to encompass hospital accr editation and renamed it the National Agency for Accreditation and Evaluati on in Health. In March 1999, the National Agency for Health Products was es tablished. It controls the safety of medical products and evaluates product s' medical benefits before reimbursement decisions. Health technology asses sment is now related to virtually every health policy process in France, an d its role increases continually.