The "Health Benefit Basket" in France

Area of Science:

• Health Economics
• Public Health Policy
• Healthcare Reimbursement Systems

Background:

• The French healthcare system reimburses services via a
• Health Benefit Basket
• which primarily uses positive lists.
• Hospital services financed by global budgets are implicitly defined.
• Two fee schedules, Classification Commune des Actes Médicaux (CCAM) and Nomenclature Générale des Actes Professionnels (NGAP), define reimbursable curative care.

Purpose of the Study:

• To outline the structure and criteria for inclusion in the French Health Benefit Basket.
• To describe the process of updating positive lists for healthcare reimbursement.

Main Methods:

• Analysis of the French healthcare reimbursement framework.
• Examination of the criteria and authorities involved in updating reimbursement lists.

Main Results:

• Reimbursable services are defined by explicit positive lists (CCAM, NGAP) and implicit global budgets for hospitals.
• Effectiveness is the primary criterion for adding procedures to reimbursement lists, assessed by the High Health Authority.
• Complementary health insurers play a consultative role in the inclusion process.

Conclusions:

• The French system relies on defined positive lists for reimbursement, emphasizing effectiveness.
• The High Health Authority and complementary insurers are key stakeholders in managing the Health Benefit Basket.