Changing hospitals during care remains a right guaranteed by the public health code, but the actual procedure goes far beyond a simple verbal request. From retrieving the medical file, coordinating between teams, to administrative transfer, each step conditions the continuity of care.
Medical file and My health space: preparing the transfer in advance
The success of a hospital change primarily relies on mastering the medical file. Article R.1112-11 of the public health code guarantees patients the right to access all their documents. We recommend submitting the request in writing to the director of the establishment or the responsible physician of the department, specifying the desired documents: surgical reports, imaging results, biological assessments, consultation letters.
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Since the generalization of My health space, patients can upload reports, imaging, and prescriptions to their digital profile themselves. This changes the game: the continuity of care no longer solely depends on exchanges between establishments. The new hospital accesses the shared documents without waiting for postal mail or a fax between secretariats.
Knowing how to change hospitals for a patient also involves anticipating transmission times. An establishment generally has eight days to communicate the file after a written request. In practice, medical archives services are often overwhelmed, and it is advisable to follow up the request with a call to the head of department’s secretary.
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Role of the primary care physician and CPTS in changing hospitals
The primary care physician is the pivot of the establishment change. In the coordinated care pathway, they are the ones who refer the patient to another hospital via a liaison letter or a regional secure messaging system. Without this guidance, the patient may face higher out-of-pocket expenses for certain specialized consultations.
The rise of territorial professional health communities (CPTS) and multi-professional health centers is changing practice. City doctors directly request opinions and consultations in other establishments through the secure messaging systems set up by the ARS. This short circuit prevents the patient from having to multiply administrative steps.
For complex pathways (oncology, chronic diseases), some university hospitals have established positions for pathway reference nurses. This professional concretely assists with the transfer:
- Scheduling appointments at the new establishment and verifying the availability of the appropriate technical platform
- Retrieving and transmitting medical file documents between the two hospital services
- Explaining to the patient the medical and administrative stakes related to the change, including the impact on the treatment schedule
When this system exists, we observe that the time between the decision to change and the first consultation at the new hospital significantly decreases.
Administrative transfer: admission formalities and health insurance coverage
The administrative aspect is the one that patients underestimate the most. The discharge from the old establishment must be formalized by a situation report or discharge notice signed by the attending physician. Without this document, the new hospital may face difficulties in opening the admission file.
At the time of entry into the new establishment, the following documents are requested by the admissions department:
- Updated vital card and recent rights certificate
- Complementary health insurance card or mutual insurance certificate
- Referral letter from the primary care physician or referring specialist
- Identity document and, if applicable, work accident report
A technical point often overlooked: if the patient changes hospitals during an ongoing hospitalization (inter-hospital transfer), the medical transport is prescribed by the physician of the originating establishment and covered by health insurance. The patient does not have to organize or advance the costs of this transport, provided that the medical transport prescription is established before the move.
On the other hand, if the change occurs between two distinct stays (the patient is discharged and then admitted elsewhere for a new scheduled stay), the coverage of the transport depends on the medical reason and distance. The primary care physician then prescribes the transport if the patient’s condition justifies it.
Patient consent and recourse in case of transfer refusal
Article L.1111-4 of the public health code establishes a clear principle: no medical act can be performed without the free and informed consent of the patient. This principle also applies to transfers. A hospital cannot transfer a patient to another establishment without informing them and obtaining their agreement, except in cases of vital emergency.
Conversely, a patient wishing to change hospitals may encounter resistance from the healthcare team, especially when the transfer is deemed medically contraindicated. In this case, the physician must document in writing the reasons for their opposition and inform the patient of the risks involved.
If the disagreement persists, the patient can contact the user commission (CDU) of the establishment. This commission, present in every hospital, examines complaints and can make recommendations. The trusted person designated by the patient plays a useful role here: they attend medical meetings and help formalize the request.
A well-prepared hospital change relies on three concrete levers: mastering one’s medical file via My health space, coordinating with the primary care physician, and verifying administrative formalities before admission. The right to freely choose the establishment exists, but its implementation requires anticipation that neither the hospital nor health insurance will handle on behalf of the patient.