Dn the current health care system coexist on one side of public hospitals to which we purposely add the term “business” which would force them to be managed as such, that is to say according to the dogmas of orthodox economics based on private experience, and on the other side clinics, opportunely renamed here and there “private hospitals”, subject in principle to obligations of “public service mission”.
The two types of structures are supposed to compete, for the greater good of their “customers” – new name given to patients or patients. In order for this competition to be fair, a total price convergence, the T2A (activity-based pricing) between the two types of public and private establishments is applied by the public authorities.
In the same way that the term “company” gives hospital activity its commercial connotation, the term “client” gives the patient a consumerist and possibly protest-oriented character.
A reciprocal mistrust
We can ask ourselves: are doctors in public hospitals first and foremost doctors or public service agents free from any constraint? Are self-employed physicians first and foremost caregivers or financiers concerned with their profit? Let us refrain from answering this legitimate question with such a caricatural dichotomy.
Care activity retains a relational character in its largest domain. An individual reputed to be knowledgeable, qualified and approved by the public authority, develops with the person who consults him an “between them” of eminently variable quality, character and duration. Whatever the level of technicality associated with this relationship, a structural inequality subsists more or less underground, whether the relationship is imbued with trust or underpinned by mistrust.
The blind confidence in them once claimed by those who were sometimes our masters seemed to absolve them of all responsibility in the event of an unsatisfactory outcome for a patient. Subject to the obligation of means and not of result, the practitioner rarely saw his responsibility involved.
Nowadays, on the contrary, a reciprocal distrust creeps in between the doctor – anxious not to be confronted with justice – and the patient who is inclined to question the competence and the merits of the professional’s decisions. The latter retreats to the shelter of the ramparts of “Evidence-Based Medicine”, medicine based on evidence, which dictates his conduct through pre-established protocols, while the patient puts on the costume of the consumer of care: reading of the rankings of establishments in the weekly press, surfing on Internet forums, defense by associations of victims of medical accidents or users.
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