France has always been a pioneer of
smart card technology, first deploying its use in the healthcare industry in the early ‘90s. Simplifying the reimbursement system was essential in this country where over 1B healthcare claims are generated every year.
Symbol of the French universal health care scheme
The SESAM-Vitale scheme introduced a smart
health card named"Carte Vitale", part of a wider electronic health care solution, containing data to simplify administration, slash costs and provide a faster, more efficient and secure way of submitting claims.
The second generation, Carte Vitale 2, has been deployed over four years starting in March 2007 with family cards issued to every person over 16 years of age eligible for French social security coverage.
Nationwide, Vitale 2 cards have gradually replaced the Vitale 1 cards distributed in 1998/1999. Vitale 2 includes enhanced security features such as a new operating system, cryptographic capabilities and larger memory. Because protecting privacy is of the utmost importance, specific attention was also paid to the personalization processes in order to ensure a high level of security for each individual's data.
2018 facts and figures
- 368,261 health professionals are using the system as of March 2019
- 99,6% of all pharmacists are using the system
- Patients are now reimbursed within 5 days
- 1.247 billion electronic claim forms were processed in 2018; over 92% of all claim forms
- 59 million cards in circulation. source GIE Sesam-Vitale
The SESAM-Vitale program, and the green smart card that embodies the success of the French universal health care in the eyes of the French people:
- have simplified live
- have been an accelerator in the computerization of health professionals’ workplaces
- is contributing to the modernization of relationships between patients and the health care system.
Slashing admin costs
According to the data processing department of the CNAM, processing of an electronic medical expense claim form only costs 0.27 Euros on average, whereas a paper-based version sent by post costs 1.74 euros. This results in a saving of around 1.8 billion Euros per year (excluding specific data-processing expenditure whose total cannot be isolated).
The number of employees has been reduced by 15% (12,000) as well as the number of offices in regions.
Contributing to sustainable development
The contribution to sustainable development is obvious :1,27B e-claims processed in 2018 means the equivalent of nearly 2,5 billion A4 documents which no longer need to be filled, sent, processed and stored.
However a precise measurement is very difficult, even impossible, as the changes are complex.
Contribution to health statistics
Beyond this economic result, the SESAM-Vitale
system has other attributes such as the coding of
treatments and pathologies, that have contributed to
the medicalization of the Health Insurance industry’s
information systems and which was necessary for the
calculation of reimbursements, not only on the basis
of administrative data from the invoice but on the
basis of the healthcare and treatments prescribed.
These data are key both for administrative and medical statistics.
The near future
Today, with the administrative sector largely paperless, it remains for it to move forward with new services such as DP (Pharmaceutical Dossier) and the Personal Health File (Dossier Médical Personnel or DMP) towards even more promising horizons for public health and the drive to sustainable development. In actual fact, this is not just about facilitating relationships with patients, but quite plainly continuing to improve the health and longevity of the French people.
People born in France today can expect to live to 82.7 years. France comes #10 after Hong Kong, Japan, Italy, Singapore, Switzerland, Spain, Iceland, Israel and Australia.
However time and communication efforts will be necessary as 13% of French patients have a DMP as of May 2019 according to Le Moniteur des pharmacies.
General agreement on success
There is general agreement on one thing: the Vitale smart card is the very symbol of these positive changes. It is real, put forward as ‘proof’ that the system has changed. It is the sign of modernity. The development of ‘reception’ services in conjunction with the implementation of universal medical coverage known as CMU in France, has been brought about very rapidly.
A contribution to French sustainability policy
SESAM-Vitale project is one of the three emblematic French programs most often cited to illustrate the concept of paperless procedures. As was recognized by the report France Numérique 2012 (the French development plan for the digital economy), ‘France has already embarked on the path of e-government and has had success with the income tax return, paperless medical expense claim forms and the development of ‘télé-TVA’, where companies can record and pay VAT over the Internet’.