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Special ReportIntegrated Health System for Chronic Disease Management: Lessons Learned From France
Section snippets
French System for Patients With CRI
To fully understand the significance of the French system for US health reform, it must be placed in an historical perspective. The key to its development was the evolution of two systems in the regions surrounding Lyon and Paris, the two largest cities in France. The regional system serving Lyon and the surrounding area is known as L'Association de la Region de Lyon pour la Lutte contre la Poliomyélite (ALLP) and began in 1960. The system serving Paris, known as Association d'Entraide des
Clinical Outcomes
ANTADIR, ALLP, and other components of the French health-care system were not established as randomized prospective experiments in patient care or health-care organization and delivery, so it is difficult to isolate and attribute changes in patient outcomes over time to the effects of these organizations. Nonetheless, from its inception ANTADIR has used the large scale of its population base to systematically study and optimize the parameters for home oxygen therapy.2728 The 10-year survival
French Financing
France has a universal health insurance system. This system is employer-based, offers consumers the freedom to choose their providers and hospitals, and includes both for-profit and nonprofit providers. Health insurance is compulsory, and the unemployed are subsidized through a centralized indigent fund administered by the Ministry of Health.31 Public health policy is determined by “les caisses,” which are quasi-public agencies. Overall national policy is determined by the major caisse, Caisse
Prevalence and Costs of Chronic Respiratory Patients in the United States
Chronic respiratory failure is caused by intrinsic pulmonary diseases (including restrictive diseases, developmental disorders, infectious diseases, and, most commonly, COPD) and diseases affecting the chest wall, component muscles, and their neurologic control (most commonly poliomyelitis, cervical spine injury, amyotrophic lateral sclerosis, muscular dystrophies, and kyphoscoliosis). The American Association for Respiratory Care defines a chronic ventilator-dependent patient as “… a patient
Experience With HMV in the United States
HMV for patients with respiratory failure also began in the United States as a result of the polio epidemics. With the decline of polio after the introduction of polio vaccines, the specialized centers and expertise to manage these patients atrophied.42 HMV became a relative rarity until the development of the “Katie Beckett” waivers, developed in the 1980s under the leadership of Surgeon General Koop, allowed Medicaid funding for children requiring HMV.43 Thus, the data describing the recent
Recent Trends Affecting Chronic Care
As a result of the Olmstead decision, “thousands of people currently living in ‘more restrictive settings’ such as public institutions and nursing homes must be offered housing and community-based supports.”50 The lead agency for Olmstead planning efforts in most states is the state Medicaid agency. The Olmstead decision potentially requires that Medicaid beneficiaries receiving long-term mechanical ventilation who currently reside in institutional settings be offered the opportunity for
Lessons Learned From France
What are the lessons from France and the Lyonnaise regional system for CRI that might be useful as states seek to comply with Olmstead?
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The importance of physician leadership. Our study of the Lyonnaise regional system, as well as other international best practices,53 highlights the importance of physician leadership coupled with support from key public officials. Throughout our interviews, public officials and others cited Dr. Robert's dedication to quality patient care, commitment to
Conclusion
France is rated by the World Health Organization as No. 1 in overall health system performance among all 191 member states58(by comparison, the United States ranked No. 37). The French health system is considerably less costly than the US system. France spends $2,115 per capita per year on health care, or 9.3% of the gross domestic product, as opposed to the United States, which spends $4,358, or 12.9% of gross domestic product. Between 1990 and 1999, health spending increased 2.1% in France,
References (63)
Home care for life-supported persons: is a national approach the answer?
Chest
(1986)Outcomes of home care for life-supported persons: long-term oxygen and prolonged mechanical ventilation
Chest
(1996)- et al.
Predictors of survival in patients receiving domiciliary oxygen therapy of mechanical ventilation: a ten-year analysis of ANTADIR observatory
Chest
(1996) Pooling public and private funds in the patient's interest: the case for long-term care insurance
Soc Sci Med
(1996)- et al.
Long-term oxygen therapy at home: compliance with medical prescription and effective use of therapy; ANTADIR Working Group on Oxygen Therapy Association Nationale de Traitment á Domicile des Insuffisants Respirations
Chest
(1996) - et al.
Predictors of survival in patients receiving domiciliary oxygen therapy of mechanical ventilation: a 10-year analysis of an ANTADIR Observatory
Chest
(1996) - et al.
Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure: a prospective study
Chest
(1997) Scope of the COPD problem in North America
Chest
(2000)COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity
Chest
(2002)- et al.
The ventilator-assisted individual: cost analysis of institutionalization vs. rehabilitation and in-home management
Chest
(1992)
Mechanical ventilation beyond the intensive care unit: report of a consensus conference by the American College of Chest Physicians
Chest
Frequency, causes, and outcome of home ventilator failure
Chest
Economic value of caregiver effort in maintaining long-term ventilator-assisted individuals at home
Heart Lung
The influence of surgical specialty training on the outcomes of elective abdominal aortic aneurysm surgery
Vasc Surg
The prevalence of COPD: using smoking rates to estimate disease frequency in the general population
Chest
Executive Order 13217: Community-based alternatives for individuals with disabilities; press release
Secretary Thompson announces creation of the Office on Disability: press release
HHS urges states to continue to expand home and community based care for disabled residents: press release
Does the chronic care model also serve as a template for improving prevention?
Milbank Q
Changing the chronic care system to meet people's needs
Health Aff (Millwood)
Controlling health care expenditures
N Engl J Med
Medicare
N Engl J Med
Managed care in transition
N Engl J Med
Medicaid
N Engl J Med
Long-term care for the elderly with disabilities: current policy, emerging trends, and implications for the twenty-first century
The organization and financing of health services for persons with disabilities
Milbank Q
Home care services for severely physically disabled people in England and France: case-example; the ventilator-dependent person—international exchange of experts and information in rehabilitation: fellowship report
Home care and alternatives to hospitalization in France for medical technology dependent children and adults with severe chronic respiratory insufficiency: the associative system; fellowship report
Home Care for life-supported persons in France: the regional association
Rehabil Lit
Home care for life-supported persons: the French system of quality control, technology assessment and cost containment
Public Health Rep
Cited by (41)
Mental health reported in adult invasive home mechanical ventilation through a tracheostomy: A scoping review
2022, International Journal of Nursing Studies AdvancesCitation Excerpt :However, being profoundly disabled, such as those who are mechanically tracheostomy-ventilated at home, is associated with natural and expected limitations in terms of their opportunity to handle the responsibilities in life in a meaningful way on their own (Dreyer et al., 2010a; Briscoe and Woodgate, 2010; Dyrstad et al., 2013; Stuart and Weinrich, 2004). Therefore, these findings highlight the need for organised and individualised treatment and care for the people receiving this treatment (Stuart and Weinrich, 2004). The findings also highlight the need for mental health competencies among personal assistants to ensure successful collaboration (Dreyer et al., 2010a; Briscoe and Woodgate, 2010; Dyrstad et al., 2013) allowing tracheostomy-ventilated people to take on the desired responsibility.
Growth of home respiratory equipment from 2006 to 2019 and cost control by health policies
2022, Respiratory Medicine and ResearchCitation Excerpt :Impaired airway clearance in a context of neuromuscular disease can be reduced by prescribing mechanical insufflation-exsufflation (MI-E) [5]. In France, home respiratory equipment can be easily used at home as a result of the optimal collaboration between hospital medical teams, physiotherapists and home health care providers [6]. However, the number of patients treated by HRE, the associated costs and the variations of these parameters over recent years remain unknown.
Where should we initiate domiciliary noninvasive ventilation in chronic respiratory failure patients? A wrong debate?
2010, Revue des Maladies RespiratoiresCardiovascular risk factors in men and women with obstructive sleep apnoea syndrome
2010, Respiratory MedicineCitation Excerpt :We wished to compare the prevalence of these risk factors between men and women. Consecutive patients with OSAS were included on CPAP initiation, over a period of eighteen months, in 10 homecare associations in the federated ANTADIR network (Association Nationale pour les Traitements A Domicile, les Innovations et la Recherche).11 The diagnosis of OSAS was established by full polysomnography or by nocturnal respiratory polygraphy.
Self-reported inhaler use in patients with chronic obstructive pulmonary disease
2010, Respiratory MedicineCitation Excerpt :Prescribing simple dosing schedules may also help patients remember to use the inhalers as they are intended. Cost is another important consideration.21,22 Prescribers should continue efforts to use the most cost-effective inhalers or explore financial assistance for patients, where applicable.
This research was partially supported by the Robert Wood Johnson Foundation. The views presented are those of the authors.