Report to Parliament 2026 on innovative health experiments

1️⃣ ANALYTICAL SUMMARY

A device that has reached maturity, serving the breaking down of silos. Created by the LFSS 2018, Article 51 allows for exemptions from pricing and organisational rules to test new models "in real life" (p.5). As of 31/12/2025, 1,339 projects submitted, 166 experiments authorised of which 114 completed, 1.5 million targeted beneficiaries, €540 million consumed (p.6). The report addresses structural tensions — ageing, chronic diseases, medical deserts, breaks in care — by betting on the organisational innovation, less visible than technology but deemed decisive (p.13). Target audiences: newborns, children, elderly people, people with disabilities, those in precarious situations, general population (p.5). Predominantly outpatient funding (city 45%, mixed 31%, hospital 18%, medico-social 5%) via the FISS (p.6, p.44).

A directory of models and a support engineering. The document brings two things to the field: first an operational inventory of six proximity levers (restructuring of the offer, mobile offer, facilitating digital, skills enhancement, territorial cooperation, user participation), illustrated with detailed "zoom" sheets (p.16-29); then the description of a project's journey — emergence, structuring "without distorting", accelerator, workshops (specifications, implementation, reinforced, end of XP), evaluation, transitional period, transposition (p.31-47). It finally maps each experiment by national priority (paediatrics, mental health, obesity, cancers, addictions, disability, healthy ageing, digital, exit from all-T2A), useful for linking a local project to an existing roadmap (p.50-59).

2️⃣ KEY POINTS OF THE DOCUMENT

1️⃣ 166 authorised experiments, 39 models towards common law. As of 31/12/2025: 1,339 projects submitted, 166 authorised, 114 completed, 33 in transitional period; the editorial announces 39 proven models transposed or about to be (p.2, p.6). A selective system: only 12% of submitted projects achieve authorisation to experiment (p.46).

2️⃣ Systems already generalised, therefore mobilisable today. Dental emergencies regulated via centres 15 have transitioned to common law in 2025 (43% of calls resolved without travel, p.19); OSyS (triage at the pharmacy) is generalised in 2026 after partial integration in 2024 for sore throats and cystitis (p.25); community-based sexual health centres are now included in the public health code (CSMSS, p.55).

3️⃣ Mobile services as a response to dependency and isolation. Mobile oral health units in EHPAD (Finistère, Puy-de-Dôme, Eure-et-Loir), transposition expected mid-2026; mobile mental health teams (SIIS, HOME, DIPPE) as an alternative to hospitalisation; Dentistadom for dependent elderly people (p.20-21).

4️⃣ Digital always backed by a human organisation. RR Télédom (tele-rehabilitation for COPD), EMNO (therapeutic education for obesity, the origin of the enhanced coordinated pathway), Oz (alcohol detection, application + tele-diagnosis, authorised Nov. 2025), AKO@dom-PICTO (monitoring of oral anticancer drugs city-hospital): digital is a tool for proximity, never a substitute for connection (p.22-24).

5️⃣ A structured and quantified support engineering. The Accelerator 51 (created in 2019) mobilises workshops for specifications, implementation, reinforcement and end of XP; cumulative 2019-2025: 124 CDC workshops, 142 implementations, 83 end of experimentation, 50 communities of practice (p.39-40). The evaluation progressively integrates PROMs and PREMs to objectify the experiences of users (p.41-43).

3️⃣ ACTION TRACKS FOR LOCAL ACTORS

1️⃣ Identify a transferable model for your territory from the thematic mapping (p.7) and priority sheets (p.50-59): identify the “generalised” (Gé) or transitional (sas) devices, directly mobilisable, rather than starting from scratch.

2️⃣ Reuse models already in common law : request dental regulation from the 15 centres (p.19), direct to OSyS in pharmacies for everyday ailments (p.25), or to a health and sexual health mediation centre (CSMSS) for exposed populations (p.55).

3️⃣ Structure a local response in fragile areas by drawing inspiration from the instruction method of pharmacy antennas in Occitanie (needs assessment via regional data, field confirmation, consensus building with the order/URPS, support for the application file — p.36).

4️⃣ Activate ARS/DCGDR support from the idea, in early and informal dialogue: their role is to secure without distorting, to position the project within the territorial offer and to support as a “coach” at key moments (p.32, p.35). For an interregional project, aim for support from the national team and the accelerator (p.38).

5️⃣ Integrate users from the design and evaluation stages (co-construction and not co-consultation, p.34), relying on PROMs/PREMs tools to document experiences beyond medical-administrative indicators (p.41-43).

6️⃣ Unmet needs / adaptations to anticipate : the report itself notes that the role of users in the carrying remains "a point of improvement" (p.41), that some evaluation protocols stabilise too late and weaken the work (p.42), and that the appropriation of qualitative lessons by decision-makers remains partial (p.43). For a carrier: secure the evaluation protocol early and plan for transposition from the "end of XP" workshop (often dreaded but deemed necessary, p.39).

4️⃣ ADDITIONAL REFERENCES

1. ARS Île-de-France — Patient Reported Measures: how to deploy patient experience questionnaires (PREMs/PROMs), guide, May 2025. Directly complements the section "role of patients" in the report (p.41-43). → https://www.iledefrance.ars.sante.fr/system/files/2025-05/Comment%20d%C3%A9ployer%20des%20questionnaires%20exp%C3%A9rience%20patient_v1.2.pdf
2. ARS Île-de-France — Article 51: what future for the experiments of pathways created within the framework of the system?, December 2025. Illuminates the issue of exit/generalisation (transitional period, CTIS/CSIS opinion) at the heart of chapter 3. → https://www.iledefrance.ars.sante.fr/article-51-quel-avenir-pour-les-experimentations-des-parcours-crees-dans-le-cadre-du-dispositif
3. ARS Auvergne-Rhône-Alpes — The Article 51 system: innovating to transform the health system, updated June 2026. Operational regional panorama (ongoing, transitional, completed experiments) useful for situating a local approach. → https://www.auvergne-rhone-alpes.ars.sante.fr/le-dispositif-article-51-innover-pour-transformer-le-systeme-de-sante

5️⃣ FREQUENTLY ASKED QUESTIONS (FAQ)

1️⃣ What is the difference between an "experiment" and an "innovation" in the system? The experiment becomes an innovation when, after a positive evaluation, it enters a transitional period ("gateway") on the favourable advice of the CTIS and the CSIS, awaiting transposition into common law (p.5).

2️⃣ Who can carry an Article 51 project? Any actor in the health system: establishments, CPTS, patient associations, individual professionals, groups. More than half of the experiments are carried out by groups of actors or establishments (p.6, p.31).

3️⃣ How is a project funded? By the Fund for Health System Innovation (FISS, art. L.162-31-1 CSS), which covers derogatory remuneration, evaluation, seed funding, and engineering; supplemented by the FIR for regional projects (p.44).

4️⃣ What concrete support is available for a project holder? The Accelerator 51 offers four types of workshops: specifications, implementation, enhanced (in case of difficulty), and end of experimentation; the "end of XP" workshop prepares for the two possible outcomes (termination or transposition) — p.39.

5️⃣ What provisions are already accessible in common law? The regulation of dental emergencies (2025), OSyS for sore throats/cystitis (2024) then generalisation (2026), community-based sexual health centres (CSMSS, registered in the CSP), the enhanced coordinated pathway for complex obesity (from EMNO) — p.19, p.25, p.55, p.52.

6️⃣ How is the voice of users taken into account? At two key stages (design and evaluation), with the deployment of PROMs and PREMs by the Evaluation Unit; a practical guide for evaluators is expected in 2026 (p.41-43).

7️⃣ What is the actual success rate? Since 2018, 12% of submitted projects have been authorised to experiment; among them, nearly one in two experiments receives a favourable evaluation and the positive CTIS/CSIS opinions paving the way for transposition (p.46).

6️⃣ REWRITING IN EASY TO READ LANGUAGE

What is Article 51?

It is a law from 2018. It allows for testing new ways of providing care. We first test in a small area. If it works, we extend it to the whole of France.

What we have done so far

• 1,339 projects have been proposed.
• 166 projects have been authorised.
• 114 projects are finished.
• 39 projects will become the rule for all.

Examples that work

• A pharmacy can open a small sales point in a village. This helps residents get their medications.
• A dentist answers the phone at 15 on weekends. He gives advice. This avoids unnecessary travel.
• Teams go to care for people in their homes. This is useful for elderly or sick individuals.
• Applications help patients track their health. A professional is always in contact.

What matters

• We listen to patients. We ask for their opinions.
• Each project is thoroughly checked before being expanded.
• Health agencies (ARS) assist project leaders.

7️⃣ CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy : the report highlights digital technology "backed by a human organisation" and simple identification (Oz), but does not detail tools suitable for low levels of understanding on the users' side (p.22-24).
• Empowerment : users are involved in design and evaluation; however, ownership by the users themselves remains "a recognised area for improvement" (p.41).
• Participation : mechanisms of co-construction are described (SECPA, Pascia'Mans, Ariane), with a clear stance of "co-construction and not co-consultation" (p.28, p.34).
• Community health : collective dimension present via CSSAC/CSMSS (community approach and health mediation) and MSMA in Occitanie (p.33, p.55).
• Ethics : the report acknowledges its evaluation limits (selection bias of cases, late protocols) but does not conduct a critical analysis of the cultural or social biases of the systems (p.42-43).
• Human rights : equity and inclusion structure several axes (precarity, migrants, disability, Pact of Solidarities), with an explicit objective of access to care for the most vulnerable (p.55-56).
• Intersectorality : recurring health/social/medico-social partnerships (ARGOS 2, DRAD, Ariane), city-hospital-ESMS coordination highlighted (p.26, p.36).
• Partnership : formalised collaboration models (consortia, public-private-associative co-ownership like AKO@dom-PICTO; paid multiprofessional meetings like IatroPrev 2) — p.27, p.34.
• Fight against discrimination : the report targets exposed audiences and "beyond the walls" (sexual health, precariousness), and highlights situations of domestic violence revealed by the MSMA (p.33); non-judgment is implicit but not thematised as such.

8️⃣ EVALUATION OF THE RELIABILITY OF THE RESOURCE

• Scientific relevance : average to good for an institutional document. Internal sources (ministry, Cnam, DREES) are consistent, evaluation methodology described (feasibility/effectiveness/transposability, PROMs/PREMs), current data (31/12/2025 and 28/07/2026). Caveat : this is not an independent evaluation; the results are selected and the demonstrative scope. To be cross-referenced with the final reports of external evaluations and the DREES/HAS work.
• Operational relevance : high. Actionable "zoom" sheets, reproducible instruction method (p.36), clarified support pathway, national priority mapping directly exploitable to link a local project.

9️⃣ STRATEGIC HASHTAGS

#Article51 #InnovationInHealth #AccessToCare #HealthOfTerritories #CarePathways #PatientExperience #HealthDecompartmentalisation #healthpractices