You might hear about the franchise médicale from time to time when the French government weighs increasing it to finance the social security system. The franchise médicale is applied to prescriptions, visits to 'paramedical' professionals (including appointments with nurses, physiotherapists and masseurs, speech therapists and eye specialists), and non-emergency medical transport. It is not applied to any medicine given out during a hospitalisation or emergency transport, neither does it apply to normal doctor appointments.
"If I have to summarize it in one word, I would say the biggest challenge in claims and reimbursement is guess work," said Puneet Maheshwari, senior vice president and general manager of Optum Real, to the audience on Tuesday. "The guesswork that happens on the provider side. The guesswork that happens on the payer side leads to significant amount of work and overhead for both parties involved ...."