A transparent debate to save the public hospital

Editorial of the “World”. The public hospital crisis takes an acute turn. Seventeen months after the Ségur de la santé agreements which devoted 8.2 billion euros to the upgrading of professions in healthcare establishments, the government has just granted, as a matter of urgency, a monthly bonus of 100 euros net to some 30,000 nurses working in critical care.

The gesture, welcome, has all the clogging: it is absolutely necessary to prevent caregivers from leaving their posts, while the country is once again faced with a strong epidemic recovery. The crucial problem is overwork due to a lack of personnel: “We should hire 25,000 caregivers just to fill vacant positions”, recently evaluated Frédéric Valletoux, the president of the Hospital Federation of France. This is in fact impossible, because the number of students in these fields is currently insufficient.

For two years, the crisis due to Covid-19 has highlighted the state of disrepair in which the public hospital is located. The awareness is both brutal and cruel, because the hospital system has long been considered a French gem. Departures and absenteeism of paramedical personnel, shortage of doctors, closing of beds, deprogramming of operations, all the symptoms in reality testify to an existential crisis over which the left and the right tend to cast a modest veil, because they are there. closely associated.

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The current difficulties are in fact the result of a series of decisions taken over the past twenty years in relative consensus. In the name of the fight against the debt and public deficits, it was necessary to rationalize health expenditure, reduce the number of doctors, introduce profitability criteria in the management of the hospital, close the less profitable establishments and accept that caregivers are underpaid.

The lack of coordination between city medicine and hospital medicine further aggravated the tensions. In many areas referred to as “medical deserts”, hospital emergencies have become the only place to go when needed at night or on weekends.

“Debureaucratise” the hospital

The 18 billion euros of investment announced within the framework of the Ségur of health show that the awareness is there: to save the hospital, the government is ready to put the means. All the presidential candidates go in the same direction. All are committed to investing, to hiring massively and promise to upgrade the trades. Many also want to respond to the governance crisis that is undermining the morale of healthcare workers. They promise, rightly, to “debureaucratize” the hospital by giving autonomy to the heads of service.

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However, one question remains taboo: that of funding. Health spending currently represents 12.4% of national wealth, a little less than what is incurred in Germany or Switzerland. Do we now consider that in the name of national well-being they should be allowed to increase significantly faster than GDP? In this case, who should finance them and how?

Because the country is at a turning point, the presidential campaign must be an opportunity to clearly pose this debate which concerns us all. Until now, unfortunately, the subject has remained confined to the opinions of specialists, hidden behind a technicality which it is urgent to eradicate.

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A transparent debate to save the public hospital