[French National Authority for Health].

The French National Authority for Health (Haute Autorité de Santé, HAS) was created in 2004. The aim of this study was to examine three of its principal responsibilities, namely certification of healthcare facilities, definition of chronic illnesses (ALD, affections de longue durée), and production of clinical practice guidelines. The authors did not assess other HAS responsibilities, such as the role of the drug evaluation and reimbursement committee (Commission de Transparence). Healthcare facility certification cost at least 22.4 million € in 2012 and involved 89 HAS personnel and 681 external auditors; medical issues were considered from only a very general and theoretical standpoint, leading the national ombudsman (Cour des Comptes) to qualify them as "blind spots". HAS is required to provide only an overall assessment of each healthcare institution, even though different departments may be of highly variable quality. Chronic illnesses are somewhat vaguely defined, permitting flexible interpretation by health insurers' medical experts. This leads to considerable disparities from one region to another in the number of patients qualifyingfor this status. Finally, practice guidelines must be more firmlly based on the results of the most rigorous and properly referenced scientific studies, and the resultinzg documents must be written more strictly, clearly and briefly, hi conclusion, HAS performance in the three roles we examined is disappointing Certification of healthcare institutions could be replaced by unannounced inspections by the General Welfare Inspectorate, health insurers, or regional health agencies. The definition of chronic illnesses and the production of practice guidelines could be handed over to scientific societies or academies, as illustrated by the case of hypertension.