The reform of the hospital landscape continues with a bill organising hospital networks, adopted on 14 February 2019. The bill aims to finally put in place a statutory framework for the affiliation by hospitals to a common network. This practice, which for many years was relatively unregulated, will now be subject to clear and strict rules. However, the question arises as to whether the legislature has adequately reflected on all consequences of the new statutory framework.
The law obliges hospitals to cooperate within a network to achieve better coordination of care and optimise the resources used, be they expertise, equipment or infrastructure. Cooperation will take place through local-regional networks and supraregional agreements.
Local-regional networks are the new centre of gravity for hospital systems. Hospitals will be required to organise themselves into 25 networks guaranteeing local-regional care, i.e. care which, for reasons of cost or urgency, must be provided in the vicinity of the patient's home.
Supraregional care, on the other hand, will be provided by a limited number of hospitals (for reasons associated with the cost of the infrastructure, specialised expertise, etc.), called "reference points", with which the networks must conclude a cooperation agreement.
Governance, freedom and procurement
The law introduces a new key concept: governance. Each local-regional network will have legal personality and management organ. It should be noted that this will not entail a merger - the hospitals that make up a network will maintain separate legal personality and remain responsible for the performance of tasks not assigned to the network.
How much leeway will the hospitals that form part of a network have in practice?
The practice of forming hospital networks initially developed due to the economic and practical advantages arising from the purchase of goods and services in bulk. Hospitals thus organised themselves around a central purchasing body (centrale d'achat).
The new networks will certainly fill the role of a central purchaser with the notable difference that adherence will now be mandatory, which was not previously the case. Nor will the choice and number of members be open for discussion. Centralisation means large orders and the standardisation of purchases. There is thus a risk of a higher management organ ordering goods that are unsuited for the personalised needs of the various hospitals in a network.
Let's not forget the interests of healthcare practitioners…
Healthcare practitioners have questioned the compatibility of subjecting the hospital sector to public procurement rules with their freedom to determine patient care (liberté thérapeutique). It goes without saying that the goods and services ordered by hospital networks must form the object of a public tender procedure. Practitioners might fail to understand when these goods and services will have to be chosen at a higher level of governance. Decisions regarding the medicinal products and medical devices used on a daily basis by healthcare professionals could thus be taken by persons far removed from specific needs on the ground….or at least the situation could be perceived this way.
…and the pharmaceutical sector
The pharmaceutical sector will have to rethink its relations with hospitals. Instead of making the rounds of hospitals and contacting the persons responsible for purchasing (the head pharmacist, manager, etc.), pharmaceutical company representatives will have to deal with the network's management body.
The purchasing power of hospital networks will clearly be much greater than that of the current central purchasing bodies. Pharmaceutical companies will have to pay attention to the heightened risk of stock shortages. In this regard, it should be noted that large orders could exclude SMEs from certain contracts due to their inability to supply sufficient quantities.
Moreover, the legislature should probably consider adapting the public procurement rules relating to the supply of medicinal products and medical devices. Currently, the quantities indicated in such contracts are "estimated quantities provided for indicative purposes only". Reliance on estimated quantities, which has already proven problematic, is liable to become untenable in practice and reform is therefore necessary in order to deal with the new behemoths. To be continued.