Prevention is not optional for a French health center (centre de santé): the law defines it as a facility “carrying out prevention, diagnosis and care activities.” Organizing a prevention pathway means connecting what the center already does, from screening to follow-up, around the prevention check-up fully covered (100%) by French National Health Insurance (Assurance Maladie).
What is a health center, and why is prevention part of its definition?
A health center is a local health care facility with salaried professionals, open to all, that mainly provides services reimbursable by health insurance and that, by legal definition, practices prevention. This definition makes it the natural home for a coordinated prevention pathway.
The framework: Article L6323-1 of the French Public Health Code
The text, in the version in force since April 1, 2018, is precise: “Health centers are local health care facilities providing primary care and, where applicable, secondary care, and carrying out prevention, diagnosis and care activities, within the center, without inpatient accommodation, or at the patient’s home. Where applicable, they provide multi-professional care, involving medical professionals and allied health professionals.” It adds that “every health center, including each of its satellite sites, mainly provides services reimbursable by health insurance” and that centers “are open to anyone seeking medical or allied health care.”
According to the FNCS (the French national federation of health centers), managing organizations are nonprofits: local authorities of all sizes, associations, foundations, universities, hospitals; supplementary health insurers (mutuelles) also run centers, and the Mutualité Française (FNMF) is a signatory of the national agreement. Professionals are salaried employees and the center bills for services. Centers charge the standard regulated fees (tarifs opposables, with no extra fees) and practice direct billing (tiers payant), so patients pay nothing upfront.
How many centers, and which ones?
When the 2025 agreement was signed, French National Health Insurance counted “more than 3,000 health centers” under agreement, compared with 2,000 in 2019: 44% medical or general, 42% dental, 14% nursing. Multi-professional centers, those combining doctors and allied health professionals, numbered 647 in 2023 according to the IGAS (French General Inspectorate of Social Affairs) report relayed by the FNCS, compared with 586 in 2022 and 356 in 2016. The same report notes that patients in precarious situations (covered by the Complémentaire santé solidaire, France’s free or low-cost supplementary coverage, or by AME, state medical aid) make up 18.2% of patients on average, compared with 10% in self-employed practice, and a median operating deficit of 9.8%. Two structural facts: centers reach populations with poor access to prevention, and they have no margin for unfunded initiatives.
What does the 2025 national agreement for health centers change for prevention?
The national agreement signed on August 28, 2025 between the organizations representing health centers, the National Union of Health Insurance Funds (UNCAM) and Unocam (the national union of supplementary health insurers), deemed approved on October 1, 2025 and published in the Journal officiel (France’s official gazette) on October 15, 2025, adds a “prevention” focus to lump-sum payments and simplifies them from 2026. It is the reference text for funding a pathway.
| Measure in the 2025 agreement (ameli.fr) | What it changes for a prevention pathway |
|---|---|
| Removal of the “common blocks” and “complementary blocks” of lump-sum payments, applied from 2026 | A clearer grid, geared “to the achievement of objectives” for quality and coordination |
| New “prevention” focus in lump-sum payments | The prevention pathway becomes a funded activity, to be documented with indicators |
| Extension of the deprivation supplement to patients with a long-term condition (ALD) and recipients of the disabled adult allowance (AAH) | Recognizes the extra time devoted to the most exposed populations |
| “Team active patient list” indicator | Rewards care shared among several professionals at the center |
| Automatic workforce incentives for eligible FTEs; medical assistant quota raised to 4 to 8 contracts | Freed-up medical time, part of which can go to prevention |
| Inclusion of measures from the medical agreement: medical assistants, transition to the regular doctor lump-sum payment | Alignment with self-employed practice |
| Announced budget: “€30 million in 2026” | A national order of magnitude, to be shared among more than 3,000 centers |
The documents (consolidated agreement, annexes, methodological payment guides, membership form) are published on ameli.fr. For a neighboring CPTS (local health professional network), we describe the area-wide counterpart in our guide on the CPTS prevention mission.
Why organize a prevention pathway rather than isolated services?
Because a health center already has everything a pathway requires, but in separate pieces: a reception team that knows the patients, several professions under one roof, a shared record, a managing organization that bills. Connecting these pieces turns scattered services into a measurable pathway, with no new job and no new premises.
There are three concrete reasons. The first is equity: health centers have nearly twice as many patients in precarious situations as self-employed practice, and these are the people who benefit least from screening and vaccination. The second is economic: the prevention check-up is a service paid €30, and each risk factor identified opens the way to reimbursable care within the center (dental consultation, dietary follow-up, physiotherapy, midwife, vaccination), in keeping with the clinical indication. The third is contractual: the 2025 agreement funds prevention and teamwork based on objectives, which a documented pathway makes it possible to demonstrate.
The foundation: Mon bilan prévention
Mon bilan prévention, France’s national prevention check-up program, is “a time for discussion dedicated to health prevention” lasting 30 to 45 minutes, offered once per person at ages 18-25, 45-50, 60-65 and 70-75, fully covered (100%) by French National Health Insurance, with no upfront payment. The decree of May 28, 2024 (arrêté du 28 mai 2024) designates the professionals who carry it out, doctors, midwives, nurses and pharmacists, and sets the fee at €30 in mainland France and €31.50 in the overseas departments and regions (DROM) (codes RDV, RDI, RDP). It takes place in three stages: risk screening based on a self-assessment questionnaire filled in beforehand, jointly choosing one or two priority topics, writing the Personalized Prevention Plan (PPP), sent to the regular doctor (médecin traitant) unless the patient objects. Our articles describe the check-up carried out by a doctor and by a nurse, as well as the Personalized Prevention Plan.
One rule matters for organization: according to ARS Pays de la Loire (the regional health agency), “no service may be billed in addition to the prevention check-up,” except prevention services under a public health program (vaccination, cervical cancer screening) and diagnostic services made necessary by a need identified during the check-up (clinical consultation, electrocardiogram). The check-up is therefore a service in its own right, not an add-on to a consultation. Billing arrangements for a facility that employs its professionals remain to be confirmed.
The complement: the preventive health examination
For patients outside the age groups, or who need lab tests, the preventive health examination (EPS, examen de prévention en santé) offered by French National Health Insurance’s health examination centers lasts about two hours, includes, depending on the profile, a blood draw, urine test, hearing and cardiorespiratory tests and a consultation, and is fully covered (100%) from age 16, with priority for people with poor access to the health system. The health center can refer patients to it and receive the findings: see French National Health Insurance’s free health check.
How do you build the prevention pathway, step by step?
A pathway comes down to seven steps, from booking the appointment to follow-up. The guiding principle: each step is handled by the person at the center who already does it, with a shared tool and a record in the patient file.
1. Identify patients at booking
Reception and the booking tool see every patient. A simple filter on date of birth identifies patients entering a Mon bilan prévention age group; a message sent with the appointment confirmation offers them the check-up and the link to the self-assessment questionnaire. Patients without a regular doctor, identified at reception, are a priority: the check-up becomes their entry point into follow-up care.
2. Have the self-assessment questionnaire completed before the visit
The official self-assessment questionnaire exists for each age group, as a PDF on ameli.fr and online in Mon espace santé (France’s personal digital health record). Completed before the visit, it keeps the consultation within 30 to 45 minutes and devotes it to the action plan. For patients less comfortable with digital tools, help filling it in in the waiting room makes all the difference. Its content by age is described in our article on the prevention check-up questionnaire.
3. Share check-ups between nurses and doctors
This is the choice that determines volume. Medical time is a center’s scarcest resource; salaried nurses, trained in patient interviews and on site continuously, can handle most check-ups, with the doctor stepping in for patients they already follow, for complex situations and for diagnostic services identified during the check-up. The midwife is well placed for ages 18-25 and 45-50 (sexual health, contraception, perimenopause); the pharmacist, if there is one, for walk-in access. No training is mandatory; the EHESP (the French School of Public Health) offers voluntary modules (motivational interviewing, brief interventions) that are useful for a team getting started.
4. Write the Personalized Prevention Plan and file it in the record
The PPP is the output of the check-up: one or two objectives chosen with the patient, dated actions, referrals. The official template can be downloaded from ameli.fr. In a health center, it has a decisive advantage: it goes into the patient’s shared record and can be read by the professional who will see the patient at the next step. When the regular doctor is outside the center, the PPP and the screening form are sent to them, unless the patient objects, via secure health messaging or via Mon espace santé.
5. Refer internally, in keeping with the clinical indication
This is where the multi-professional approach comes into its own. Smoking identified during the check-up leads to smoking cessation support; an unbalanced diet or excess weight to a dietary consultation; a sedentary lifestyle to a prescription for adapted physical activity; an overdue screening to a prescription (colorectal cancer from age 50, mammogram, Pap smear or HPV test); incomplete vaccination to catch-up shots; psychological distress to the center’s psychologist or the Mon soutien psy program (French National Health Insurance’s reimbursed psychologist sessions); neglected oral health to the dentist. Two safeguards: the referral responds to an identified and documented need, never to an activity target; and, under Article L1110-4 of the French Public Health Code, information sharing between professionals is limited to the professionals involved in the patient’s care and to information “strictly necessary for the coordination or continuity of care.”
6. Follow up over time
A plan without a follow-up appointment fades away. We recommend a check-in at three months, by phone or in a short consultation, handled by the nurse who carried out the check-up, followed by an annual reminder. The shared record makes it possible to measure what has been done and to follow up on the rest. Group workshops (physical activity, diet, sleep) complement individual follow-up for patients who share the same risk.
7. Measure and report
Indicators are set before the first check-up, along with the source of each data point and how often it is consolidated. A quarterly dashboard presented to the team and to the managing organization is enough to keep momentum going.
Which indicators should a health center track for a prevention pathway?
The contractual indicators are those of the national agreement and its prevention focus; the table below is a suggested operational dashboard, to be aligned with them.
| Suggested indicator | Type | Source | Why track it |
|---|---|---|---|
| Eligible patients identified at booking | Resources | Booking tool, reception | Measures the first link in the pathway |
| Check-ups performed by age group | Results | Billing (RDV, RDI, RDP) | Core of the program; flags neglected age groups |
| Check-ups by profession | Results | Billing | Checks that the pathway does not rely on doctors alone |
| Share of self-assessment questionnaires completed before the visit | Quality | Patient record | Preparation and controlled duration |
| Share of PPPs filed in the record and sent to an outside regular doctor | Quality | Patient record, MSSanté (secure health messaging) | Program requirement, coordination |
| Internal referrals offered and attended | Results | Patient record | Shows that the check-up leads to care |
| Screenings and vaccinations performed following a check-up | Results | Patient record, billing | Measurable effect in secondary and primary prevention |
| Share of beneficiaries in precarious situations or without a regular doctor | Equity | Billing, patient record | Expected target; link with the deprivation supplement |
| Patients seen again at three months | Follow-up | Schedule | The plan lives on after the consultation |
| Patient and professional satisfaction | Quality | Short questionnaire | Adjusting the pathway |
Two precautions. Individual data stays in the care record; the managing organization and oversight use only aggregated counts. And since no national Mon bilan prévention rollout figures have been published on ameli.fr to date, set targets specific to the center, not comparisons.
What common mistakes slow down a prevention pathway?
Pathways that run out of steam almost always share the same causes: identification left to chance, check-ups concentrated on doctors, referrals without follow-up and indicators defined too late.
- Waiting for the patient to ask. The program is not well known; without identification at booking, volume stays low. Remedy: an age filter and an automatic message.
- Reserving the check-up for doctors. Volume plateaus and medical time runs short. Remedy: nurses handle most check-ups, with a target distribution.
- Doing the check-up without a self-assessment questionnaire. The consultation runs over and the plan is rushed. Remedy: help filling it in in the waiting room.
- Referring internally without a documented indication. The pathway loses its legitimacy and exposes the center to accusations of supplier-induced demand. Remedy: each referral is linked to a risk written in the PPP.
- Forgetting the outside regular doctor. Sending the PPP is a program requirement. Remedy: a single, traceable process with an indicator.
- Not seeing the patient again. The plan fades away. Remedy: a three-month check-in scheduled on the day of the check-up.
Key takeaways
- Prevention is part of the legal definition of a health center (Article L6323-1): the pathway connects what the center already does; it does not create a separate activity.
- The national agreement of August 28, 2025 adds a “prevention” focus to lump-sum payments and rewards teamwork: a documented pathway can be funded.
- Mon bilan prévention (€30, four professions, four key ages) is the foundation; the preventive health examination complements it for other patients.
- Identification happens at booking, check-ups rely first on nurses, and every internal referral responds to a need written in the plan.
- Indicators set before the first check-up, individual data in the care record, aggregated counts for oversight.
How to organize this pathway with Sokrate
Sokrate connects to the center’s online booking system to identify eligible patients and offer them, before their visit, an adaptive questionnaire filled in at home. The professional who carries out the check-up receives a structured file, conducts the check-up and signs the Personalized Prevention Plan in the official format; internal referrals are suggested based on the risks identified, and the plan is sent to the regular doctor unless the patient objects. The center has an aggregated, anonymized dashboard (check-ups by age and by profession, dominant risks, referrals attended) to manage the pathway and document the prevention focus of the national agreement. Learn more on our page for health centers; to discuss your organization, contact us.