Lhe end of the cycle of our health system is now visible to all: closure of hospital emergency services, extended appointment times (except in the event of payment of excess fees), non-acceptance of new patients, deserts medical devices that extend…
But it must be recognized that this degradation has been at work for twenty years, while Medicare has been in deficit for a third of a century. If the past five-year term has failed to reverse the trend, could we both fight Covid-19 and reform? At the same time, this health crisis allows us to “turn the table” other than through rhetoric.
Let’s pass the law on 35 hours which, by Lionel Jospin’s own admission, had a negative impact on the organization of public hospitals [en 2014]. The abolition of on-call and on-call duty in 2003 has had devastating effects, with only 40% of general practitioners participating in it today, leading to an overload of activity in hospital emergencies.
Culture administrative
In 2009, the Hospital, Patients, Health and Territory (HPST) law, Nicolas Sarkozy’s major health reform, established a single boss at the hospital but, against all odds, decreed that it would be an administrative one! Thus, contrary to the Anglo-Saxon world and our European neighbours, a non-caregiver (therefore without scientific legitimacy) would make decisions and arbitrate between research or high-tech medical issues.
Between 2012 and 2017, defender of the HPST law, Marisol Touraine [ministre des affaires sociales et de la santé] yet let the administrative culture encumber hospital functioning in an increasingly heavy yoke. Faced with the drift of hospital finances, fifteen thousand hospital beds have been closed without a significant salary increase for caregivers.
Finally, in 2016, technocracy invented the territorial hospital grouping (GHT), extending the territorial millefeuille to the hospital. This additional administrative layer has, according to a report by the Court of Auditors in 2021, not produced significant results.
During the 2017-2022 period, when all the indicators were red and the time for diagnosis had passed, Agnès Buzyn [ministre des solidarités et de la santé de 2017 à 2020] did not take immediate strong action. When the health plan was announced at the end of 2018, it was too late and not strong enough. With Covid-19, the health system has benefited from a colossal financial effort (unheard of for decades). But the Ségur de la santé failed because it did not link the essential reorganization to the financial effort allocated.
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