France
Cancer Centers
Healthcare System
France operates a Statutory Health Insurance (SHI) system, providing universal coverage to its residents through two main schemes: one primarily for the agricultural sector and another more general one. The system is financed mainly through employee and employer contributions, along with earmarked taxes on various revenues.
The healthcare system is overseen by the Ministry of Health, with the SHI managed by the Caisse Nationale de l'Assurance Maladie (CNAM). The central government retains significant control over the healthcare system, despite some decentralization to regional health agencies.
SHI covers a broad range of services, such as preventive care, specialist consultations, hospitalizations, prescription drugs, and maternity care, financing about 83% of total health expenditure. However, SHI doesn't fully cover some goods like dental and optical devices. Hospital care is covered over 90% by SHI, but it only covers 44% of costs for non-pharmaceutical medical goods in ambulatory (outpatient) care.
Supplementary private insurance (mutuelle) or Voluntary Health Insurance (VHI) plays a significant role, with almost 95% of the population having some form of VHI. Certain services not fully covered by SHI, like dental and optical care, often rely on this VHI or out-of-pocket payments.
All residents in France, including long-term foreign residents, contribute to the SHI and can access its benefits. The Assurance Maladie issues a health insurance card, the Carte Vitale, to beneficiaries. This card electronically submits claims data for reimbursement. Electronic health records (Dossier Médical Partagé) are also maintained for each patient, enabling efficient information exchange among healthcare providers. France has recently been placing more emphasis on prevention, health promotion, and patient empowerment.
Administrative or Claims Data
SNIIRAM
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM) [2].
Type of information: All health care expenses, including outpatient visits, dispensed medication, procedures, chronic conditions, hospital admission diagnoses and procedures, date of death, date and nature of lab tests without results, as well as other information.
Source of Information: Includes data from 3 main claims systems (CNAMTS, RSI, and MSA) and almost all the smaller systems.
Data level: Patient level.
Number of Records: 98.8% of the French population as of 2017.
Date Range: 2003 onwards.
Open data access: Not publicly available. Instructions to request data for restricted content [3].
Information/Contact for data request: Contact information [4].
Echantillon généraliste de bénéficiaires (EGB)
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM) [6].
Type of information: Identical to SNIIRAM, but on a smaller scale to be more manageable. The data structure is streamlined and simplified in the EGB.
Source of Information: Includes data from 3 main claims systems (CNAMTS, RSI, and MSA) and almost all the smaller systems.
Data level: Patient level.
Number of Records: 1/97 random permanent sample from the SNIIRAM database.
Date Range: 2004 onwards.
Information/Contact for data request: Instructions to access data.
PMSI
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM) [8], and Agence technique de l'information sur l'hospitalisation (ATIH) [9].
Type of information: Admission date, duration of stay, main, related, and associate diagnoses coded in ICD10, hospital admissions for medical, surgical, and obstetrical wards, and other information. All of that information is for both public and private hospitals
Source of information: Recording of standardized medico-administrative data in a standard collection of information.
Data level: Patient level.
Number of Records: 98.8% of the French population as of 2017.
Information/Contact for data request: Instructions to access data.
Open Damir: Complete Database on Health Insurance Expenditure
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM) [10].
Type of information: Six axes of analysis: period, benefit, care organization, care recipient, performing healthcare professional, prescribing health professional. Four amount indicators: total expenditure, health insurance reimbursement basis, amount reimbursed, and excess fees for health professionals. Three volume indicators: enumeration, amount, and coefficient.
Source of Information: Système National des Données de Santé (SNDS) [11].
Data level: Regional level.
Date Range: 2009 to 2021.
Open data access: Publicly available [12].
Information/Contact for data request: Contact information [13].
National data on health insurance expenditure for community care
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM) [14].
Type of information: Type of expense item, type of benefit (care and cash benefits), type of performer (doctors by specialty, dental surgeons, medical auxiliaries, analysis laboratories, pharmacists, etc.), type of prescriber, date of treatment, repayment rate, type of risk covered (sickness, maternity, accident at work and occupational disease). The expenditure indicators are: the reimbursement base of the Health Insurance, the amount reimbursed, excess fees for healthcare professionals, the count of acts performed, and coefficients invoiced.
Source of Information: Système National des Données de Santé (SNDS) [15].
Data level: National level.
Date Range: 2010 to 2022.
Open data access: Publicly available [16].
Information/Contact for data request: Contact information [17].
National health insurance expenditure data for private health facilities
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM) [18].
Type of information: Department and region of residence of the beneficiary, type of expense item, type of service, type of establishment, establishment category, benefit discipline, date of treatment, repayment rate. The expenditure indicators are: the reimbursement base of the Health Insurance, and the amount refunded.
Source of Information: Système National des Données de Santé (SNDS) [19].
Data level: National level.
Date Range: 2009 to 2022
Open data access: Publicly available [20].
Information/Contact for data request: Contact information [21].
Data by CPAM on health insurance expenditure relating to city care
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Health insurance fund (CPAM), type of expense item, type of benefit (care and cash benefits), type of performer (doctors by specialty, dental surgeons, medical auxiliaries, analysis laboratories, pharmacists, etc.), type of prescriber, date of treatment, repayment rate, type of risk covered (illness, maternity, accident at work and occupational disease). The expenditure indicators are: the reimbursement base of the Health Insurance, the amount reimbursed, excess fees for healthcare professionals, the count of acts carried out and the coefficients invoiced.
Source of Information: Système National des Données de Santé (SNDS)
Data level: CPAM level.
Date Range: 2010 to 2021
Information/Contact for data request: The data is openly available.
Data by CPAM on health insurance expenditure relating to private health establishments
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Health insurance fund (CPAM), department and region of residence of the beneficiary, type of expense item, type of service, type of establishment, establishment category, benefit discipline, date of treatment, repayment rate. The expenditure indicators are: the reimbursement base of the Health Insurance, the amount refunded.
Source of Information: Système National des Données de Santé (SNDS)
Data level: CPAM level.
Date Range: 2010 to 2022
Information/Contact for data request: The data is openly available.
Open Medic: complete database on drug expenditure
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Main Anatomical Group, Therapeutic Subgroup, Pharmacological Subgroup, Chemical Subgroup, Chemical Subgroup, Pharmaceutical Specialty Identification Code, Top Generic, Generic Group, Age at the time of care, Sex, Region of Residence of the Beneficiary, Prescriber, Amount reimbursed, Refund Basis, Number of boxes delivered, Number of consumers (available only in NB_ type bases).
Source of Information: Système National des Données de Santé (SNDS)
Data level: Regional level.
Date Range: 2014 to 2021
Information/Contact for data request: The data is openly available.
Open Medic: additional databases on drug expenditure
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Main Anatomical Group, Therapeutic Subgroup, Pharmacological Subgroup, Chemical Subgroup, Chemical Subgroup, Pharmaceutical Specialty Identification Code, Top Generic, Generic Group, Age at the time of care, Sex, Region of Residence of the Beneficiary, Prescriber, Amount reimbursed, Refund Basis, Number of boxes delivered, Number of consumers (available only in NB_ type bases).
Source of Information: Système National des Données de Santé (SNDS)
Data level: Regional level.
Date Range: 2014 to 2021
Information/Contact for data request: The data is openly available.
Open PHMEV: complete database on hospital prescriptions for drugs delivered in the community
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Main Anatomical Group, Label ATC1, Therapeutic Subgroup, ATC2 label, Pharmacological Subgroup, ATC4 label, Chemical Subgroup, ATC3 label, Chemical Subgroup, ATC3 label, Label CIP13, Top Generic/Biosimilar/Princeps/Reference, Generic Group, Age range, Sex, Establishment Category, Region of establishment of the AP-HP and the Red Cross; Region of establishment of the managing establishment otherwise, Geographic Finess number for the AP-HP and the Red Cross; No legal Finess otherwise, Top establishment according to availability Age group: 0 no; 1 yes, Top establishment according to availability Gender: 0 no; 1 yes, Number of boxes, Amount reimbursed, Refundable Amount
Source of Information: Système National des Données de Santé (SNDS)
Data level: Regional level.
Date Range: 2014 to 2021
Information/Contact for data request: The data is openly available.
Open PHMEV: regional database on hospital prescriptions for drugs delivered in towns
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Information about reimbursement of drugs prescribed by public establishments and Espic (private health establishments of collective interest) and dispensed in community pharmacies.
Source of Information: Système National des Données de Santé (SNDS)
Data level: Regional level.
Date Range: 2014 to 2021
Information/Contact for data request: The data is openly available.
Open Statins: comprehensive database on statin spending
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Main Anatomical Group, Therapeutic Subgroup, Pharmacological Subgroup, Chemical Subgroup, Chemical Subgroup, Pharmaceutical Specialty Identification Code, Top Generic, Generic Group, Age at the time of care, Sex, Region of Residence of the Beneficiary, Prescriber, Amount reimbursed, Refund Basis, Number of boxes delivered, Number of consumers (available only in NB_ type bases)
Source of Information: Système National des Données de Santé (SNDS)
Data level: Regional level.
Date Range: 2014 to 2021
Information/Contact for data request: The data is openly available.
Open Statins: additional bases on statin expenditure
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Main Anatomical Group, Therapeutic Subgroup, Pharmacological Subgroup, Chemical Subgroup, Chemical Subgroup, Pharmaceutical Specialty Identification Code, Top Generic, Generic Group, Age at the time of care, Sex, Region of Residence of the Beneficiary, Prescriber, Amount reimbursed, Refund Basis, Number of boxes delivered, Number of consumers (available only in NB_ type bases)
Source of Information: Système National des Données de Santé (SNDS)
Data level: Regional level.
Date Range: 2014 to 2021
Information/Contact for data request: The data is openly available.
Registries
Death registry (CepiDC)
Primary purpose: A complete registry of medical causes of death in France.
Sponsor, manager, or home institution: Center for Epidemiology on the Medical Causes of Death (CépiDC)
Data level: Patient level. Open data available at Regional and National level.
Collected information: Complete database: Patient name, address, date of birth, sex, date and time of death, medical component that includes the sequence of morbid events that led to death from the immediate cause to the underlying cause of death as well as the comorbidities, factors or physiological conditions that contributed to the death but not directly involved in the sequence of events described before. Open database: Sex, age, and cause of death.
Number of records: Unknown.
Data source: Death certificates issued in the country.
Cancer areas of interest: Malignant tumor of the lip, malignant tumor oral cavity and pharynx; malignant tumor of the esophagus; of the stomach; malignant colon tumor; malignant tumor of the rectum and anus; malignant neoplasm of the liver and intrahepatic bile ducts; malignant tumor of the pancreas; malignant tumor of the larynx, trachea, bronchi and lung; malignant melanoma of the skin; malignant breast tumor; malignant tumor of the cervix; malignant tumor of other parts of the uterus; malignant tumor of the ovary; malignant tumor of the prostate; kidney malignancy; malignant bladder tumor; malignant neoplasm of lymphatic and hematopoietic tissues; other malignant tumors,; other tumors.
Data availability: Partial open data
Link/contact: Information to access complete data.
Databases for Clinical Trials, Surveys and Biobanks
Epidemiology Portal of France
Primary purpose: Catalog of individual french health databases to facilitate the development of research and public health.
Sponsor, manager or home institution: Inserm.
Type of databases: Administrative bases, morbidity registries, cohort studies, longitudinal studies, case-control studies, cross-sectional studies. Includes but is not limited to cancer databases.
Database information: Identification, medical domain, health determinants, scientific manager, collaborations, funding, database governance, database type, origin of participation recruitment, primary objective, type of population, year of first and last collection, database size, base activity, type of data collected, clinical trials details, administrative details, methodology, validation and access.
Data access: Check "Validation and Access" section for the relevant database.
Link to specific query: Cancer-related databases.
Compilation: ESMO Patient Guides
Sponsor, manager or home institution: European Society for Medical Oncology
Primary purpose: To translate complex medical language into understandable information for patients.
Available guides: Cancer Treatment During the COVID-19 Pandemic; Immunotherapy Side Effects and Their Management; Personalized Medicine; Survival; Colorectal Cancer; Endometrial Cancer; Stomach Cancer; Gliomas; AML; CML; Follicular Lymphoma; Bone Sarcomas; Non-Small Cell Lung Cancer (NSCLC); Head and Neck Cancer; Soft Tissue Sarcomas.
Type of information: Information on each guide varies for each cancer type. Generally, guides provide definitions, explanations of causes, diagnosis, treatment, treatment options, care after treatment, among others.
Access to information: List of guides [4].
Latest Policymaking Initiatives
CNAM Studies and Data
Primary purpose: Offer access to publicly available databases and reports made by CNAM.
Sponsor, manager or home institution: Caisse Nationale de l'Assurance Maladie (CNAM)
Type of information: Health reports and databases that include but are not limited to cancer reports and databases.
Link to specific query: Cancer-related reports
