The private practice nursing market - France

As of 2020, the French market for self-employed nurses has shown significant growth, with a 20.39% increase in the sector over four years, despite a relatively stagnant French population growth of 1.28%. The number of self-employed nurses rose by 9.47% between 2017 and 2021, outpacing the overall population growth. Self-employment among nurses is also on the rise, with the sector expecting further acceleration due to the "avenant 10" agreement in 2023, which proposes to raise the fixed travel allowance by 10%. The demand for homecare services, particularly due to an aging populace, has fueled this growth, with self-employed nurses playing crucial roles in various care services ranging from routine to specialized care.

The geographical distribution of private practice nurses is uneven, with disparities in patient-nurse ratios across different regions and departments. There's a movement to encourage more nurses to work in under-serviced areas through incentive contracts introduced by the Convention Nationale des Infirmiers Libéraux.

Despite the flourishing sector, regulations are strict, with nurses bound by fixed tarifs and prohibited from engaging in direct advertising or operating in commercial premises. The financial aspect for self-employed nurses indicates that expenses account for roughly 52% of total revenue. Notably, the proportion of foreign nurses in France remains low, in part due to the administrative hurdles in recognizing foreign qualifications.

Robust Growth and High Demand in French Self-Employed Nursing Market

The French market for self-employed nurses has exhibited a significant expansion over the past few years This increase suggests a strong inclination towards independent nursing as a career choice, reflecting both dynamism in the sector and a growing need for healthcare services outside traditional hospital settings.

Among the total nursing population, the proportion choosing self-employment has seen a slight uptick, increasing by around half a percentage point in four years. Furthermore, surveys indicate that a substantial majority of nursing graduates—approximately 84 percent—expressed intentions to continue working in the nursing field, with nearly 30 percent of salaried nurses considering a transition to self-employment within five years. This expansion in the market can be attributed to an increase in both the average number of patients per nurse and the number of nurses opting for self-employment.

While the French market for private practice nursing is experiencing such growth, the role played by these professionals remains multifaceted. Offering a variety of services ranging from routine care to more specialized offerings, self-employed nurses confront diverse demand stemming from different patient groups. This demand is complexified by chronic diseases, with a notable 13 percent increase in the number of patients with chronic illnesses (ALDs).

The aging population of France further compounds the need for home healthcare and liberal nursing services. To manage the burgeoning demand and offer tailored healthcare outcomes, the French market has exhibited a geographical variability in the supply of self-employed nurses. With the patient-to-nurse ratio varying significantly from one region to another, we see areas with higher patient numbers presenting both opportunities and challenges for nursing professionals.

Lastly, the economic aspects of self-employment in nursing reveal that the average incomes and expenses have undergone changes over the years.

Pioneering Forces in France’s Flourishing Self-Employed Nursing Market

As France's self-employed nursing market demonstrates robust growth and dynamism, a constellation of main players orchestrates the symphony of care that weaves through the nation’s healthcare fabric. These entities range from regulatory bodies and professional associations to technological innovators, each playing a vital role in shaping the landscape of nursing services for France's diverse population needs.

• Agence Régionale de Santé (ARS) : reigns as a key regulator in the market, focusing efforts on equitable healthcare distribution. It diligently maps out zones of nursing supply, highlighting areas of saturation and scarcity. ARS’s zoning strategy is a critical countermeasure against the looming shadow of medical deserts, as it works tirelessly to incentivize self-employed nurses to serve in underserved communities.

• The Conseil de l'Ordre des Infirmiers : stands as the custodian of professional ethics and conduct. This governing body is paramount in ensuring that self-employed nurses adhere to the standards that uphold the sanctity and reputation of the profession, through the enforcement of a stringent code of ethics and professional practice. 

• ARCOLIB : a technological platform designed for accounting and business management specific to the needs of independent healthcare practitioners. This tool aids self-employed nurses by simplifying the intricacies of financial administration, allowing them to focus more on patient care and less on ledger lines. The backdrop of the market is also defined by UNASA.

• UNASA (Union Nationale des Associations Agréées) : defines the backdrop of the market which sheds light on the economic aspects of practice by providing valuable data on nurses’ revenues and expenditures, painting a clearer financial picture for the industry.

• Ameli : the official website of the French Health Insurance, plays a pivotal role in informing self-employed nurses about their tariffs, reimbursements, and other regulatory aspects of their services. As a beacon for official information, it bridges the gap between policy and practice, facilitating a smooth navigation through the financial streams of nursing care.

 Together, these players not only position themselves but also the entire market in a state of readiness to address the continuous ebb and flow of France’s healthcare demands. It is through their collaborative synergy that the market retains its vibrancy.

Inforamtion

• Number of pages : 30 pages
• Format : Digital and PDF versions
• Last update : 12/09/2023

Summary and extracts

List of charts

• Size of the French private practice nursing market (APE*)
• Number of self-employed nurses (APE)
• Proportion of self-employed nurses among nurses
• Number of ALD* patients
• Revenues, expenses and average annual results for self-employed nurses
• Average inflation per year
• Comparison of average accounting income and expenses for self-employed nurses
• Foreign nurses in France
• Percentage of nurses trained abroad
• Age groups in the French population
• Projection of age groups in the French population in 2050
• Number of patients in palliative care treated at home in 2021
• Hospital admissions in 2020