Anesthetic process, organization, management and economic issues: the French perspective

PURPOSE OF REVIEW: Anesthesia is a three-step process: preoperative evaluation, the intervention itself and postanesthetic care. In France, this scheme has been legally regulated since 1994. Since then, significant progress has been made in terms of safety. Nevertheless, challenges in the delivery and financing of anesthesia services persist; in particular, demographic (patients and medical staff, as in other western countries), budgetary and organizational restrictions. RECENT FINDINGS: The poor efficiency (i.e. low utilization rate) of operating sites remains problematic. Results of published surveys yield the same observations: low productivity (anesthesia personnel present and paid but insufficiently occupied with mean occupied-time rate of approximately 60%), absence or poor planning and inadequate risk management. The failure to define policies to obtain better distribution of anesthesiologists throughout the country and to optimize operating-suite use are major barriers. In addition, the appropriate composition of anesthesia teams, for example nurses and physicians, for specific procedures remains undefined. Moreover, the number of anesthesia cases has grown constantly over the past 20 years, and in some situations they are not medically justified. Finally, pressure to increase productivity is becoming a potential threat to safety and deserves more discussion. SUMMARY: Paths to improvement of delivery of anesthesia in France may include: more optimal sharing of medical resources; better utilization of operating sites, perhaps by consolidating and reducing locations; applying improved organizational skills; and improved risk management.