A consensus definition of population-based responsibility in France using the nominal group technique

Background: The French healthcare system faces several public health challenges, leading it to integrate new approaches such as population responsibility. This has been promoted since 2017 by the French Hospital Federation, and the approach has been enshrined in law since 2019. However, the content of its definition remains vague and does not answer all the questions raised by those working in the field. 

 

The objective of our research is therefore to propose a consensus-based definition based on expert opinion to ensure a shared vision in France. 

 

Approach:To do this, we first conducted a review of international literature focusing on definitions of the population-based approach, including the concepts of “population health management” and “integrated care.” Definitions from gray literature were added to supplement the results. 

Next, using the nominal group technique, we brought together 15 French experts. The expert group is composed of public health physicians, stakeholders in population responsibility in France (specialist physicians, general practitioners, nurses responsible for population responsibility, patient partners, citizens) and supervisory authorities (Directorate General for Health, Regional Health Agency, National Public Health Agency). 

 

Results: At the international level, Population Health Management is associated with the “Triple Aim,” which aims to improve the health of a given population and the healthcare experience at the lowest possible cost, whereas definitions of Integrated Care tend to focus on the needs of the individual. 

 

In Belgium, the approach focuses on integrated care and combines the Quintuple Aim, adding two objectives: improving the well-being of health and social care professionals, and improving equity in health and the social sector. 

 

Finally, in Canada, the definition of population responsibility combines integration objectives in the health and social sectors with health determinants, through intersectoral partnerships. 

In France, population responsibility is defined in the Public Health Code as “all healthcare actors in a given territory being responsible for improving the health of the population and providing optimal care for patients in that territory.” The FHF adds to this with the concepts of the “Triple Aim” and responses to the expressed and unexpressed needs of the population on a continuum of interventions. 

 

Based on an exploration of these international definitions, the main ones will be presented to a group of French experts. This group will meet in the last quarter of 2025. Drawing on their expertise (experience, profession, training), they will be able to formulate a consensus definition of population-based responsibility. 

 

The French consensus definition of population-based responsibility will then be presented in preview at the ICIC congress. 

 

Implications: International literature on integrated care and population-based approaches still lacks French experiences. 

 

This consensus definition, based on a group of experts, will enable the representation of population-based responsibility in France to be presented at the international level.