The private practice nursing market - France (2023)

1.2 The French market

The French market for self-employed nurses is booming (***)

Size of the French private practice nursing market (***) France, **** - ****, in billions of euros Ameli

With average fees remaining stable, this growth can be explained by an increase in the average number of patients at the same time as an increase in the number of self-employed nurses.

Growth is set to continue and even accelerate with the signing of the "avenant **" agreement in ****, which will raise the fixed travel allowance for self-employed nurses by **% (***).

Number of self-employed nurses (***) France, ****-**** Ameli

Between **** and ****, the number of self-employed nurses in France rose by *.**%, compared with just *.*% for the French population (***). This shows the strong popularity of this career choice and a certain dynamism in the activity.

Proportion of self-employed nurses among nurses France, **** - ****, in percent DREES Not only is the number of self-employed nurses on the rise, but the proportion of self-employed nurses among the French nursing population is also up slightly (***).

According to an OREF Grand Est survey, in ****, **% of graduates plan to continue working as nurses. Among salaried nurses who still plan to be working in * years' time, around * out of ** plan to be self-employed

Self-employment therefore appears to be particularly ...

1.3 A special market

The liberal nursing market in France is distinguished by its hybrid professional nature, combining clinical autonomy and entrepreneurship. Unlike traditional markets, private practice nurses operate as independent healthcare professionals: They are required to run their own practices, take care of administrative management, while guaranteeing the quality of care. What's more, the French healthcare system strictly regulates their practice and the pricing of their services, creating a subtle balance between local care provision and individual business management - a unique feature compared to more conventional markets.

Private practice nursing is governed by the French Public Health Code, and private practice nurses are bound by precise tariffs. Their services are reimbursed to the patient (***) by social security and the patient's mutual insurance company.

In France, nursing care can be preventive, curative or palliative, and is provided either independently or on the basis of a doctor's prescription. Patients are reimbursed up to **% by the Assurance Maladie, with a deductible of *.** to * euros per procedure, althougha mutuelle santé may help cover the remaining out-of-pocket expenses. (***), which operate on medical prescription, are reimbursed at ***% by the Assurance Maladie, except for certain specific treatments.

1.4 Comparing the status of self-employed nurses in France and abroad

The status of private practice nurse in France is a particularity that does not necessarily have an equivalent in other countries. The aim of this section is to compare the French model with other countries.

To obtain a nursing diploma, * years of training are required in France, compared with * years in Spain. In France, a minimum of * years' experience is required for private practice. Self-employed nurses in Spain are regulated by the nursing colleges of each province, while in France they are under the direction of the national nursing order. In Spain, self-employed nurses are not obliged to be autonomous, depending on their volume of activity and clientele. In Spain, self-employed nurses are free to set their own tariffs, whereas in France, tariffs are set by the NGAP. In Spain, professional nursing is exempt from IVA tax, but the self-employed nurse must pay ***.** euros per month to the social security system. In France, taxes for self-employed nurses vary according to annual turnover. Finally, in Spain, patients can pay the nurse directly, whereas in France, the health insurance pays the nurse according to the acts performed.

In Belgium , we speak of self-employed nurses, a booming sector. The number of self-employed nurses in ...

2.1 Typology of demand

Private practice nurses provide different types of care depending on patient needs, and each of these patient groups represents a specific clientele with particular nursing care requirements.

-Elderly patients, mainly those aged ** and over, include retired people living at home or in retirement homes. They require routine care such as injections, blood sampling, dressings and regular medical follow-up for age-related conditions.

-Chronically ill patients, generally aged ** and over, suffer from conditions such as diabetes, hypertension, heart and respiratory diseases. They require specialized care and education for self-monitoring of their condition.

-Post-operative patients, of all ages, have recently undergone surgery and require assistance during their recovery phase.

-Pediatric patients, including infants, children and adolescents, require services such as vaccinations, wound care, pain management and training for parents on home care.

-Palliative care patients, with advanced serious illness, require pain management, comfort maximization and emotional support.

2.2 Chronic diseases

Patients with chronic illnesses (***) often require ongoing, regular care, which may include regular visits from private nurses. These conditions, such as diabetes, heart disease, cancer or chronic respiratory illness, require long-term management and monitoring of health status. Patients with ALD often require complex care, such as injections, dressing changes, wound care, blood pressure assessments and so on. Self-employed nurses are the health professionals best placed to provide this care in the comfort of the patient's home, or in their own practice.

Patients with ALD often have co-morbidities, i.e. other health conditions in addition to their ALD. This makes the role of independent nurses all the more crucial in managing these patients' overall health.

Number of ALD* patients France, **** - ****, in millions * Affection longue durée Ameli There will be a **% increase in the number of patients with an ALD in France between **** and ****, due in particular to the aging of the population: ALDs are more frequent among the elderly, and France is experiencing an aging population.as the proportion of elderly people rises, so does the demand for home healthcare, including liberal nursing services.

2.3 Population aging

According to Insee, the aging of the population will continue in France and around the world.

In France, by ****, **% of the population will be aged over **, compared with just **% in ****. It should also be noted that the French population aged over ** should triple in volume by **** compared with **** (***)

Age groups in the French population France, ****, in percent Insee Projection of age groups in the French population in **** France, *****, in percent Insee According to these projections, the population over ** will rise from **.*% to **.*%. The population aged over ** will see an even more impressive increase: from *.*% to **%. Let's now consider the determinants of poor health in France, according to Drees: Since ****, France has maintained a stable mortality rate from carbon monoxide (***) poisoning, with a higher prevalence among men and a correlative increase with age. Despite a reduction in pollutant emissions, air pollution remains a major problem, causing adverse health effects, particularly among vulnerable people. fine particles, produced by human activities, are responsible for thousands of premature deaths every year. Alcohol consumption has fallen, mainly due to a decline in wine consumption. However, heavy binge drinking is on the rise. Daily smoking fell slightly in ****, after an increase between **** and ****, but exposure to home ...

2.4 Palliative care

When we look at the number of palliative care patients who received home care from private nurses, we obtain a total of ***** patients, with the following breakdown:

Number of palliative care patients receiving home care in **** France, **** Court of Auditors

2.5 Post-operative patients

In ****, around **.* million people in France were hospitalized at least once in an acute-care medical, surgical, obstetric and dental (***). In ****, ***.* million days of hospitalization were recorded in France, an increase attributed to the aging of the population and the development of partial hospitalization. At the same time, full hospitalization fell, with **.* million stays recorded, a particularly notable decline in medicine, surgery, obstetrics and dentistry. Hospitalization at home increased, accounting for *.*% of full hospitalization days in ****, mainly in the private non-profit sector.

Hospitalization in **** France, ****, in millions DREES

The number of people hospitalized gives us valuable information on the number of people requiring care from private nurses

3.1 Value chain

Source: ****

3.2 Types of self-employed nurses

Self-employed nurses in France can choose between tenure, collaboration and replacement. Tenure offers total independence, but entails greater responsibility and requires a good working relationship with the other members of the practice. Setting up a practice can be complex, with numerous administrative formalities. Collaboration offers premises, equipment and an existing patient base, while maintaining administrative, tax and accounting independence, but limits the possibility of working in several collaborations and requires adaptation to the existing organization. Substitution is ideal for those just starting out in their career, and reduces the administrative burden, but hinders the development of one's own patient base and requires a high degree of mobility.

Mixed practice:

The Code of Ethics of the French Nurses' Association (***). Remember that when you combine your activities, you also have to pay social security contributions, both as an employee and as a self-employed worker.

3.3 Geographical distribution of self-employed nurses

The French market for self-employed nurses is particularly marked geographically:

Here, we will consider APE nurses (***)

Source: ****

(***)

Demand for private practice nurses in France varies considerably at both regional and departmental level, reflecting the specific needs of each area. This data is crucial to understanding the country's liberal nursing market, helping to identify the geographical areas where demand is highest and those where supply is insufficient.

In France, the average number of patients per private practice nurse varies significantly from region to region, and even between departments. Notable differences can be observed in the Centre-Val de Loire region, where the average number of patients per private practice nurse is the highest (***). These variations could indicate potential business opportunities for private practice nurses in high-demand regions, but they also highlight the need to take these regional disparities into account when setting up a new private practice.

At departmental level in France, there are notable differences in the patient-nurse ratio. For example, in Bouches-du-Rhône, each private practice nurse cares for an average of *** patients, while in Essonne, this figure rises to *** patients per private practice nurse. These disparities reveal inequalities in access to nursing care across the country. In areas where ...

3.4 Foreign self-employed nurses

Foreign nurses in France France, **** - ****, in percent OECD

It has been observed that the percentage of foreign nurses practicing in France remains particularly low, and has shown notable stability in recent years. This consistency in figures suggests that the contribution of foreign nurses to the nursing workforce in France is limited. Furthermore, it is important to note that this trend is influenced, in part, by the administrative challenges that foreign nurses may face when considering self-employment in the country. These administrative difficulties, such as qualification requirements, diploma recognition procedures, and regularization procedures, can constitute significant obstacles for foreign nurses wishing to practice as self-employed nurses in France. As a result, it is plausible to conclude that the number of foreign nurses opting for a career as a self-employed nurse in France remains relatively small. For nurses with foreign qualifications, there are two options: - The diploma is European, so you either need to have a professional license if you want to set up your own practice, or you need to declare your occasional practice. - If the diploma is not European, the nurse cannot, in theory, practice in France. unless there is a bilateral agreement between France and a European ...

4.1 Tariffs, expenses and income of self-employed nurses

The financial management of a private nursing practice includes fixed charges such as rent, car insurance, rental costs for the carte vitale reader, cell phone package and management and teletransmission software. It also includes social charges, such as contributions to Urssaf and Carpimko (***), which vary according to income. In addition, various expenses can be deducted from taxes, including service charges, overheads, subscriptions, medical equipment, office supplies, practice rental costs and professional travel expenses, offering a significant tax opportunity for these healthcare professionals.

Average inflation per year France, **** - ****, in percent

Average annual revenues, expenses and results for self-employed nurses France, **** - ****, in thousands of euros ARCOLIB

According to Insee data, between **** and ****, prices have risen by around **%, compared with an increase of around **% in revenues for self-employed nurses (***). This suggests that the purchasing power of self-employed nurses has increased between these two periods

Table of compulsory tariffs for professional acts performed by self-employed nurses.

According to UNASA, the accounting profit of self-employed nurses in **** averaged €**,***, or **% of revenues on average. Assuming a relative stability of expenses over the years for self-employed nurses, we can therefore estimate the total amount of expenses incurred by self-employed nurses on their total revenue at around ...

4.2 A potential geographical shift in the supply of self-employed nurses

The geographical distribution of the supply of self-employed nurses is particularly marked, especially in recent years.

Source: ****

The Agence Régionale de Santé (***) has introduced nursing zoning to balance the distribution of private practice nurses across France. This system aims to combat medical deserts and remedy the shortage of private practice nurses. The territory is divided into five categories according to the population density of private practice nurses:

Over-supplied and highly-supplied areas, often urban, have a large number of self-employed nurses.

Intermediate zones have a balanced distribution of private practice nurses.

Under-resourced and very under-resourced areas, often rural or far from towns, have restricted access to nursing care due to a lack of nurses. These areas represent a major challenge in terms of access to care. The ARS regularly updates the map of under-resourced areas to keep pace with changing needs.

The Convention Nationale des Infirmiers Libéraux has set up three incentive contracts to encourage liberal nurses to set up in very under-serviced areas. The Contrat d'Aide à l'Installation Infirmier (***) offers financial assistance of €*,*** per year for * years, renewable, to nurses already established in very under-serviced areas.

We can therefore expect to see an increase in the number of self-employed nurses ...

5.1 Regulations

Article R****-**: Facilities and technical resources

Nurses must have suitable facilities and sufficient technical means for patient care and safety.

Article R****-**: Place of practice

Nurses must have only one place of professional practice, unless a derogation is justified by the needs of the population. Authorization to practice in a secondary location is granted by the Director General of the regional health agency. Professional nursing partnerships are exempt from this rule.

Article R****-**: Nurses' associations or partnerships

Any association or partnership between nurses must be the subject of a written contract respecting the professional independence of each.

Article R****-**: Prohibition on fairground practice

It is forbidden to practice the profession of nursing on a fairground basis.

Article R****-**: Prohibited practice as a trade

The nursing profession must not be practiced as a business. All direct or indirect advertising is prohibited, except for essential information on the professional plate.

Article R****-**: Prohibition on practicing in commercial premises

Nurses may not practice in commercial premises, nor in premises selling medicines or products related to their activity.

Article R****-**: Prohibition on using an elective office to increase clientele

Nurses may not use an elective mandate or administrative ...