Stylized French hospital symbolizing improved patient care through financial incentives.

Boosting Healthcare Quality: How Financial Incentives Can Transform French Hospitals

Mira Elwood in Health & Wellness July 2025 • 4 min read.

"Explore the groundbreaking IFAQ experiment and its potential to revolutionize healthcare in France through financial incentives."

The concept of paying for performance (P4P) has steadily gained traction across the globe, beginning in Anglo-Saxon countries and eventually spreading to industrialized nations. These programs often use financial incentives to motivate improvements, targeting everyone from local doctors to entire healthcare facilities. The goal? To enhance the quality of care by rewarding healthcare providers—physicians, clinics, and hospitals—who meet specific, measurable goals.

In the United States, the Hospital Value-Based Purchasing (VBP) program has become a benchmark. This initiative, part of Medicare, involves nearly 3,000 hospitals and serves as a model for other countries looking to implement similar strategies. The VBP program underscores the potential of financial incentives to drive significant change in healthcare quality and efficiency.

France has been actively developing and implementing quality indicators to improve its healthcare system. This groundwork has set the stage for introducing a payment-for-quality system. Key factors driving this shift include financial pressures on French healthcare facilities, which underscore the need for efficiency and quality, and the potential to improve the existing fee-for-service model, known as T2A, which doesn’t inherently promote quality improvements.

The IFAQ Experiment: A Financial Boost for Better Healthcare

Stylized French hospital symbolizing improved patient care through financial incentives.

France launched the 'Incitation Financière à l'Amélioration de la Qualité' (IFAQ) initiative in 2011 with support from the Ministry of Health and the Haute Autorité de Santé (HAS). The primary aim of IFAQ was to develop a model tailored to the French healthcare landscape and assess its impact. The goal was to design a system that rewards facilities for enhancing the quality of care based on specific indicators.

Inspired by the U.S. VBP program, IFAQ was carefully adapted to fit the French context. The project involved several key steps:

Selecting Quality Indicators: The evaluation focused on existing quality and safety indicators, certification standards, and the level of IT integration within healthcare facilities.
Engaging Stakeholders: A dedicated working group, including hospital federations and health agencies, guided the program.
Choosing Participants: The initiative began with 222 healthcare facilities, selected to represent a diverse range of institutions across different regions.

A final pool of 185 facilities became eligible for financial incentives based on specific criteria, such as meeting indicator collection requirements and maintaining certification standards. Financial rewards were allocated based on a facility’s ranking and the financial value of its hospital activities.

Looking Ahead: The Future of IFAQ and Healthcare Incentives

The IFAQ experiment provided valuable insights into how financial incentives can drive quality improvements in French hospitals. While the program showed promise, it also revealed areas for refinement. As IFAQ evolves, it’s set to broaden its scope and incorporate new quality components. With ongoing evaluation and adaptation, IFAQ holds the potential to transform the French healthcare system, ensuring better care for all.

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This article is based on research published under:

DOI-LINK: 10.3917/jgem.154.0277, Alternate LINK

Title: Incitation Financière À L’Amélioration De La Qualité (Ifaq) Pour Les Établissements De Santé Français : Résultats De L’Expérimentation (2012-2014)

Subject: Industrial and Manufacturing Engineering

Journal: Journal de gestion et d'économie médicales

Publisher: CAIRN

Authors: M. Ferrua, A. Fourcade, B. Lalloué, A. Girault, S. Jiang, P. Loirat, Étienne Minvielle

Published: 2016-05-23

Everything You Need To Know

What is the IFAQ initiative, and how does it aim to improve healthcare?

The 'Incitation Financière à l'Amélioration de la Qualité' (IFAQ) is a French initiative launched in 2011 by the Ministry of Health and the Haute Autorité de Santé (HAS). It aims to improve healthcare quality by using financial incentives. The program rewards healthcare facilities for enhancing the quality of care based on specific indicators, much like the U.S. Hospital Value-Based Purchasing (VBP) program. This financial boost is intended to encourage French hospitals to meet or exceed certain quality standards, ultimately improving patient outcomes and overall efficiency within the French healthcare system.

How does the IFAQ experiment compare to the Hospital Value-Based Purchasing (VBP) program in the United States?

The IFAQ experiment in France was inspired by the U.S. Hospital Value-Based Purchasing (VBP) program, which is a part of Medicare and involves nearly 3,000 hospitals. Both programs utilize financial incentives to drive improvements in healthcare quality and efficiency. However, IFAQ was carefully adapted to fit the French context, taking into consideration existing quality indicators, certification standards, and IT integration levels within healthcare facilities. The VBP program serves as a benchmark, highlighting the potential of financial incentives to transform healthcare delivery, a model that IFAQ sought to emulate while tailoring it to the specific needs and structures of the French healthcare system.

What were the key steps involved in the implementation of the IFAQ initiative?

The IFAQ initiative involved several crucial steps. First, the selection of quality indicators was essential, focusing on existing quality and safety metrics, certification standards, and the level of IT integration in healthcare facilities. Second, the initiative engaged stakeholders through a dedicated working group, including hospital federations and health agencies. Lastly, the program chose participants, starting with 222 healthcare facilities, and eventually narrowing down to 185 eligible facilities based on meeting indicator collection requirements and maintaining certification standards. Financial rewards were then allocated based on a facility's ranking and the financial value of its hospital activities, incentivizing the enhancement of care quality.

Why did France decide to implement the IFAQ initiative?

France implemented the IFAQ initiative due to several key factors. Firstly, there were financial pressures on French healthcare facilities, emphasizing the need for both efficiency and quality. Secondly, the existing fee-for-service model, known as T2A, did not inherently promote quality improvements. IFAQ was designed to address these issues by introducing financial incentives to encourage better care. The primary aim was to develop a model tailored to the French healthcare landscape, assessing its impact and rewarding facilities for enhancing the quality of care based on specific indicators, similar to initiatives like the Hospital Value-Based Purchasing (VBP) program in the United States, but adapted for the French context.

What is the future outlook for the IFAQ initiative, and what are the potential implications for healthcare?

The future of the IFAQ initiative involves ongoing evaluation and adaptation, with the goal of broadening its scope and incorporating new quality components. The experiment has shown promise in driving quality improvements within French hospitals. As IFAQ evolves, it holds the potential to transform the French healthcare system, ensuring better care for all. The implications include improved patient outcomes, increased efficiency in healthcare delivery, and the potential for the model to be adapted and adopted by other countries or healthcare systems seeking to enhance quality through financial incentives. It underscores the importance of adapting successful models, like the U.S. VBP, to fit the local context to ensure effectiveness.