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Summary of our market study
Annual fees for self-employed nurses are around 9 billion euros
There are around 95,000 self-employed nurses in France, or 20% of the total number of nurses. The number of self-employed nurses grew by 9% between 2017 and 2021, outpacing overall population growth.
The sector expects further acceleration due to the "avenant 10" agreement in 2023, which proposes to increase the lump-sum travel allowance by 10%.
30% of salaried nurses plan to become self-employed within the next five years
The geographical distribution of self-employed nurses is uneven, with disparities in patient-to-nurse ratios across regions and départements.
Nurses are subject to fixed tariffs, and are prohibited from direct advertising or working from commercial premises.
The aging of the French population is accentuating the need for home care and independent nursing services.
Players in the independent nursing market in France
- The Agence Régionale de Santé (ARS) focuses on the equitable distribution of healthcare. It maps nursing supply zones, highlighting areas of saturation and shortage to combat medical deserts.
- The Conseil de l'Ordre des Infirmiers is the guardian of professional ethics and deontology.
- ARCOLIB: a technological platform designed for accounting and business management specific to the needs of independent healthcare practitioners.
- UNASA (Union Nationale des Associations Agréées): provides data on nurses' income and expenditure
- Ameli: the official website of the French health insurance system, plays an essential role in informing self-employed nurses about their rates, reimbursements and other regulatory aspects of their services.
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Summary and extracts
1 Market overview
1.1 Definition and presentation
The independent nursing market in France encompasses all activities related to the provision of nursing care outside conventional hospital structures. These healthcare professionals play a key role in delivering quality care to their patients, offering a diverse range of services including home care, vaccinations, blood sampling, injections and more.
In 2022, France counted 135,000 self-employed (or mixed) nurses among its 764,000 nurses, i.e. 17.5%. The average age of French nurses is 40.8, and 87% of them are women
The self-employed nursing sector is currently enjoying sustained growth, reflected in an increase in the number of professionals practicing as self-employed nurses among all nurses (from 2012 to 2021, the number of self-employed nurses rose by 42%, compared with 19% for all nurses). This trend is driven by the growing demand for homecare, particularly in view of the ageing population.
The liberal nursing market in France is characterized by a variety of services on offer, ranging from routine to specialist care, including mental health services and palliative care. They also play a crucial role in prevention and health education.
The liberal nursing sector is marked by strong competition, with many professionals practicing as independents or within care practices. What's more, healthcare policies and government regulations are having a major impact on remuneration methods and working conditions, particularly as regards the areas in which self-employed nurses set up practice (medical deserts).
The digitalization of the healthcare sector is also a major trend, with the development of technological solutions for electronic medical record management, care coordination and teleconsultation. These developments are enabling self-employed nurses to offer more efficient and accessible care to their patients.
The private practice nursing market in France is therefore booming, with growing demand for homecare and a variety of care services on offer.
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 ...
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 ...
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 ...
2 Demand analysis
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, ...
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, ...
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 ...
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 ...
3 Market structure
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 ...
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, ...
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 ...
4 Offer analysis
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 ...
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 ...
5 Regulations
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 ...
List of charts presented in this market study
- Size of the French private practice nursing market (APE*)
- Number of self-employed nurses (APE)
- Proportion of self-employed nurses among nurses
- Number of ALD* patients
- Revenues, expenses and average annual results for self-employed nurses
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The private practice nursing market | France
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