The future of private maternity units in France is a major issue, especially in the current context marked by a worsening of perinatal health indicators and increasing inequalities. The recently published report by the Court of Auditors highlighted significant difficulties faced by these hospitals, whether in terms of health outcomes or care effectiveness.

In this concerning context, it is essential to note that France ranks 22nd among 34 European countries in terms of neonatal mortality. This raises serious questions about the quality and safety of care provided in private maternity units. Faced with this challenge, it is imperative to understand the specific challenges they face, particularly in terms of human resources, structure, and adaptation to the evolving needs of patients.

This overview also leads to exploring the responses undertaken by these hospitals to address these challenges. Whether through internal reorganizations, technological upgrades, or initiatives aimed at reducing regional disparities, private maternity units are striving to evolve while remaining at the service of women and births in France. In this context, the prospect of better coordination with public structures could offer avenues for improvement.

Finally, the outlook for these maternity units also involves collective reflection on their place in the French healthcare system. Their role, although sometimes controversial, remains essential both for maintaining reception capacity and for providing care adapted to specific needs. The very future of perinatal care in our country and its ability to offer a secure, accessible, and high-quality framework for all expectant mothers depends on it.

Current context of private maternity units in France

Recent trends in private maternity unit activity

Private maternity units in France are currently going through a worrying period, marked by a significant reduction in their activity. Between 2013 and 2022, the number of deliveries in these establishments fell by 26.3%, while public maternity units recorded a more moderate decrease, limited to 7% during the same period. This phenomenon reflects a substantial decline in the obstetric activity of private establishments, which have lost almost half of their vitality over the years.

This decrease in the number of births is also accompanied by a significant reduction in the number of hospitals. In 2023, France had 107 private maternity units, a figure marked by a significant decrease in type 1 maternity units, from 97 to 57 between 2013 and 2022. In contrast, type 2 maternity units recorded a slight increase, rising from 47 to 52 over the same period.

Impacts of declining birth rates and recruitment challenges

The decline in the birth rate in France plays a determining role in the difficulties encountered by private maternity hospitals. While the number of births in France remains relatively stable, fluctuating between 700,000 and 800,000 per year, the proportion of births in private hospitals is decreasing alarmingly. In 2023, among the 669,449 births recorded, only 125,439 took place in private structures, illustrating a declining share.

In addition to the declining birth rate, private maternity units face considerable challenges in recruiting and retaining skilled healthcare professionals. The shortage of midwives, obstetricians, and other specialized staff is a major challenge that affects the entire sector, but private facilities are particularly affected due to their more limited financial resources compared to public structures. This situation jeopardizes their ability to guarantee quality care and meet the growing needs in the field of perinatal health.

Specific challenges for private maternity units

Competition with the public sector and attractiveness

Private maternity units in France face increasing pressure from competition with the public sector, which enjoys a robust reputation and an image of trust with the public. Public institutions, often perceived as essential in medicine and obstetrics, attract a large proportion of patients thanks to their solid reputation and direct coverage by Social Security. Consequently, the attractiveness of private maternity units is diminished, requiring sustained efforts to stand out, in particular by offering specialized and high-quality care in order to retain their patients.

Nevertheless, this differentiation sometimes remains difficult to implement due to budgetary restrictions and obstacles to maintaining competent and experienced staff. These constraints add an additional layer of complexity for these private structures.

Financial difficulties and investment in equipment

Private maternity units face significant financial challenges, primarily due to rising costs and the need to invest in modernized equipment that meets strict safety standards. The 1998 perinatal decree, which mandates adjustments in staffing ratios and equipment requirements per maternity category, has led to the closure or significant slowdown of activity in many private hospitals.

Furthermore, the Social Security solvency mechanism, which largely favors public sector hospitals, limits the financial capacities of private maternity units. While some financial groups have invested in these hospitals, attracted by a supposed profitability, these initiatives have not necessarily resolved the structural challenges related to the management and modernization of infrastructures.

Quality and safety requirements of care

To meet the high demands for quality and safety of care, private maternity units must overcome major challenges. Currently, between 10 and 15% of high-risk deliveries are performed in inadequately equipped facilities, with sometimes worrying consequences for patient care. This issue raises questions about the ability of these units to guarantee optimal standards of care and safety.

Furthermore, the decrease in the number of deliveries in certain hospitals reduces the practical experience of medical teams, which can impact the overall quality of services offered. Despite the lack of consensus on the minimum threshold of annual activities, the 1998 perinatal decree recommends a minimum of 300 deliveries per year, with some possibilities for exemption. These regulations increase the pressure on private maternity units and complicate their daily management.

Responses and adaptations by private maternity hospitals

Innovation and specialization of services

Like the current challenges they face, private maternity hospitals in France are striving to focus on innovation and specialization of their services. Many of them choose to focus on specific areas, such as the management of high-risk pregnancies or personalized care for mothers and newborns. Thus, some private maternity hospitals have established advanced neonatal intensive care units, specially designed to treat premature and seriously ill newborns, thus meeting the requirements of level 3 maternity hospitals.

Furthermore, the integration of innovative technologies, such as telemedicine and advanced fetal monitoring systems, improves the quality and safety of care. These advances not only increase efficiency; they also increase the attractiveness of private hospitals by meeting the legitimate expectations of patients, particularly in terms of high-quality care.

Collaborations with public health stakeholders

Private maternity units are also developing strategic partnerships with public health actors to optimize the continuity of care and ensure better coordination of the perinatal pathway. The initiative of the Agence Régionale de Santé (ARS) of Île-de-France, in September 2023, which aims to improve support for families leaving maternity units, perfectly illustrates this collaborative approach. This project allows, among other things, to adapt the length of stay in the maternity unit according to the criteria of vulnerability, thus guaranteeing an increased level of personalization in the care provided.

These collaborations also result in an enriching sharing of resources, skills, and best practices between the public and private sectors, fostering an overall improvement in perinatal health in France.

Strategies for attracting and retaining medical staff

Finally, to cope with the shortage of qualified healthcare professionals, private maternity units are developing targeted strategies. Ramsay Santé, for example, has consolidated its maternity activities at more efficient sites, such as the Parly 2 Private Hospital, to ensure its staff have optimal working conditions. These efforts include offering professional development opportunities for midwives, obstetricians, and other specialists, giving professionals the opportunity to thrive in a rewarding environment.

Some maternity units go even further by offering significant benefits, such as continuing education, flexible working hours, and redesigned workspaces to improve staff's daily lives. These initiatives represent a proactive response to human resources challenges and, at the same time, ensure the sustainability of quality care for their patients.

Future prospects for private maternity hospitals

The challenge of digital technology and telemedicine in obstetrics

In contrast to traditional practices, the integration of digital technology and telemedicine is an essential aspect in the evolution of private maternity units in France. The regional e-health roadmap 2023-2025, highlighted by the Regional Health Agency (ARS) of Île-de-France, insists on the need for a strategic deployment to improve access to care, particularly in the field of obstetrics.

Teleconsultations, like medical teleassistance, aim to optimize patient care, particularly in areas where medical density remains insufficient. This technological advancement could also allow for more in-depth remote pregnancy monitoring, reduce consultation waiting times, and strengthen coordination between different healthcare professionals.

The foundations of teleconsultation, planned for the summer of 2025, will play a decisive role in clarifying the methods of integration and the role of teleconsultations in the overall obstetrical care offer. This is an important step towards connected and inclusive medicine.

The role of private maternity hospitals in the regional healthcare offering

Private maternity units occupy a central position in the regional supply of care, mainly in territories where the capacities of public resources remain limited. By establishing strong partnerships with the public sector, these establishments manage to contribute significantly to a more balanced distribution of resources and medical skills.

For example, in the Île-de-France region, private maternity units belonging to groups such as Ramsay Santé actively collaborate with public units to ensure complete coverage of perinatal health needs. These synergies help to strengthen the diversity and quality of care, ensuring that each patient, whether they choose a public or private hospital, has access to services tailored to their needs.

Future scenarios: between expansion, specialization and the risk of extinction

The possible scenarios for the future of private maternity hospitals in France depend on a multitude of factors. In an optimistic scenario, these hospitals could specialize in innovative fields such as the management of high-risk pregnancies or advanced neonatal care. This specialization would offer them not only a valuable distinction in the medical landscape, but also an increased ability to attract patients seeking excellent services.

Conversely, a pessimistic scenario highlights the challenges of competition with the public sector and pressing financial issues. In this scenario, some private maternity units may be forced to reduce their activities or even close, leading to significant consequences for the national supply of care.

However, the most realistic scenario might be a compromise: a restructuring of these private hospitals, their adaptation to the new requirements of the healthcare system, and an increasing integration of digital technologies. In this case, private maternity units could continue to play a key role while optimizing their position within the French medical landscape.

Conclusion

In France, the future of private maternity hospitals is part of a changing landscape, punctuated by challenges but also stimulating perspectives. The restructuring of the sector, marked by the closure of nearly two-thirds of private maternity hospitals over the past forty years, combined with the constraints imposed by the 1998 decrees, highlights the need for rapid and strategic transformation.

These hospitals must innovate and specialize, while strengthening their links with the public system, to guarantee their recovery and sustainability. The challenges are multiple. It is essential to respond to the shortage of healthcare personnel, to face increasingly marked competition and to respect the quality and safety standards of care. The rise of digital solutions, such as telemedicine, as well as the development of specializations in advanced fields, represent key avenues for the future.

Swift action is essential to prevent a disorderly reorganization of perinatal care provision. Acting now will help secure an essential place for private maternity hospitals in the health of future generations. This calls for ambitious collaboration, strategic investment in technology and unwavering support for initiatives to improve quality and safety quality and safety.

FAQ

Why are maternity hospitals closing?

Maternity units in France are closing primarily due to several factors. First of all, a lack of profitability, particularly for small structures performing fewer than 500 deliveries per year, can lead to deficits of up to one million euros per year. Added to this is a shortage of qualified medical personnel, including anesthesiologists, pediatricians, and obstetricians. Finally, an overall decline in the birth rate reduces the number of deliveries in certain regions. The financial difficulties of maternity units are also amplified by funding standards, dating from 1998, which have now become obsolete.

Which is the best maternity hospital in France?

There is no single answer to the question, as the choice of the best maternity hospital depends on the evaluation criteria. However, the ranking carried out by Le Figaro for Paris and the île-de-France often cites the Bluets maternity hospital, located at the Pierre Rouquès hospital, as one of the most reputable facilities.

How much does childbirth cost in France without insurance?

In France, the costs of childbirth without health insurance can vary considerably. For an uncomplicated vaginal delivery in a contracted hospital, the average cost ranges from €2400 to €2600. This amount can increase to €4500 in a non-contracted private clinic. For cesarean sections, the financial costs are higher and generally vary between €4000 and €7000, depending on the type of facility.

Which private clinic groups are there in France?

Several large groups dominate private hospitalization in France:

• Ramsay Générale Santé, with 124 hospitals and representing 17% of private hospital activity.
• Elsan, which owns 120 hospitals and covers approximately 20% of the private hospital market.
• Vivalto Santé, comprising 53 specialized hospitals.
• Almaviva, operating several hospitals in Île-de-France, in the south of France and in Corsica.