Can governments push providers to collaborate? A comparison of hospital network reforms in France and the United States

Abstract

France recently implemented a program to encourage greater collaboration among public hospitals, which represent about 65 percent of total capacity, by placing them into regional groupings known as Groupements Hospitalier Territoire (GHTs) and mandating that facilities within them share several core functions. The strategy echoes that of Accountable Care Organizations (ACOs) in the United States, which offer financial incentives to providers to form networks that foster collaboration. While the programs share an underlying strategy for improving care and reducing costs, the difference in approaches, mandatory versus voluntary, could significantly affect outcomes. We analyzed aspects of the programs that could lead to differences in their results. ACOs appear to have several advantages, as financial inducements have proven effective in shaping provider behavior in other contexts. GHTs may benefit from a more direct approach, but mandatory participation risks pushback. Regardless of whether the programs succeed in fostering effective care integration, they may accelerate provider consolidation, which could impair access in already underserved areas by concentrating resources in larger facilities and promoting the closure of smaller ones.

Keywords: Accountable Care Organizations; Care coordination; France; Groupements Hospitalier Territoire; Health care reform; Hospital collaboration.