Market Access for Medical Technologies in France

Reimbursement

Reimbursements for hospital procedures are made solely via a DRG system, which is called “Groupe Homogène de Maladies” (GHM). All hospitalizations, as well as day case procedures and ambulatory treatments, are reimbursed via DRG.

The DRG system has several components.

Diagnosis-related groups:

• Each DRG in the French system has four severity levels, from level 1 (lowest severity) to level 4 (highest severity). The severity level is determined by the length of the stay, the presence of complications, the type of procedure performed, etc. There are also DRGs for a short stay, which can cover hospital day care or one-day hospitalizations
• DRGs are determined by the combination of a procedure code (CCAM) and a diagnosis code (ICD-10). 
• DRG tariffs differ between public, private not-for-profit, and private for-profit hospitals. Private for-profit hospitals have lower tariffs, but physicians practicing there receive a fee for every procedure performed, based on fees determined for each CCAM code.

Add-on reimbursement (LPPR list):

• This is an add-on reimbursement category for selected implantable (Title III) or invasive non-implantable (Title V) devices.
• The LPPR list is primarily managed by the French National Authority for Health (Haute Autorité de Santé, HAS). The industry can either make a brand-specific or a generic application to request the inclusion of its products into the LPPR catalog. Technologies for which evidence is considered sufficient are listed, and their price is determined at the national level. The price is based on the level of added value the device provides compared to the current standards of care in France.
• Clinical assessment is performed by National Committee for the Evaluation of Medical Devices and Health Technologies (CNEDiMTS), and price negotiation is performed by Economic Committee on Healthcare Products (CEPS).
• The DRG system is approved annually. The DRG system is administered by the Technical Agency for Hospital Information (Agence technique de l'information sur l'hospitalisation, ATIH). Neither the industry nor the providers have a direct impact on the development of the DRG system. However, some lobbying groups can have an impact.