Hospital, medical deserts, T2A…prescription candidates for the best French treatment

A troubled hospital, exhausted caregivers, heightened inequalities, sometimes difficult access to health care—two years of a health crisis has highlighted the shortcomings of our health care system. Most candidates agree on one thing: he was out of breath. The 2000s, when France topped the WHO ranking for “best overall health care,” seem far off. As various public opinion polls show, the hospital and the healing deserts are the main concern for applicants for the Elysee Palace and voters.

These topics are not new, difficulties in accessing a doctor have already appeared in some programs in 2017, and the hospital community was warned of tensions long before the pandemic. Zainab Riet, General Delegate of the French Hospital Federation (FHF), puts forward two main priorities for public hospitals over the next five years:

“As far as funding is concerned, we must not fall into the bookkeeping policies that we have known in recent decades. In terms of Human Resources, at least 25,000 nurses and nursing assistants need to be hired to fill the only vacant positions. It is also necessary to recognize the limitations associated with the continuity of the public service.”

The mouthpiece of public institutions requires, in particular, funding based on multi-year logic (5 years) and a minimum increase in the national health insurance spending target (Ondam) of 2.4% per year.

Check out hospital prices

There is a strong need for programs to limit or even eliminate activity-based (T2A) pricing. Introduced in 2004 to replace block funding. Its main drawback is to lead to a race for profitability at the expense of quality. ” T2A does not recommend that institutions regulate their care activities, as this directly affects the level of their resources. It rather pushes us to act on productivity,” the Accounts Chamber already noted in 2017. But should it be completely excluded?

In 2018, the current President of the Republic, Emmanuel Macron, chose a cap. “MaSanté2022 aimed to reduce T2A to 50% of total funding for establishments, explains Zainab Riet. In the public hospital, we are very close to this (about 57%), and this view is correct. The task today is to reduce its share for clinics and liberals. Why ? Because it is necessary to finance courses, prevention for all actors, which implies the limitation of funding by act. Moreover, with an aging population and continuing development of chronic diseases, there really needs to be better funding for prevention or therapeutic education consultations.

Another priority is to revise tariffs and revise the entire range of activities, because for many, remuneration is no longer suitable today. Fabienne Roussel (PCF) and Nathalie Artaud (LO) will abolish this pricing regime and Marine Le Pen (RN) will return to the global distribution system.

“We will evolve T2A to better consider the quality of care, including how patients perceive it. It will have to better reward some important missions, such as prevention or the reception of people with disabilities., indicates Valerie Pecresse’s (LR) campaign team. Yannick Jadot (EELV) to Support Hospital Funding “on the real needs of the population by reserving the pricing of activities only for technical and programmatic actions”and Ann Hidalgo (PS) will establish a fund based on “local public health needs”.

Emmanuel Macron (LREM) will continue the ongoing work, as will the reform carried out for emergencies with “population-based funding, activity-based funding focused on specific pathways of care, and quality-based funding”his team says.

Over-recruitment

Last fall, an investigation by the Scientific Council set fire to gunpowder: 20% of the beds in the hospital would have closed in the midst of a pandemic. According to the Ministry of Health, after the polls, 2% will eventually be concerned, and according to the FHF, 6%. But recruitment difficulties and absenteeism are real and put strain on the hospital and caregivers.

Result, hiring promises (and pay raises), rain: 40,000 for Eric Zemmour (right), 25,000 for Valerie Pecresse, 100,000 nurses for Yannick Jadot. Jean-Luc Mélenchon (LFI) will “Gradually open beds depending on capacity”Jean Lassalle (Ré) will create 20,000. Marine Le Pen will create “moratorium on closure”.

Other common denominators include administrative relief. Valerie Pekress defends “debureaucratization” hospital and more digital. Emmanuel Macron will continue “simplification of hospital and management” initiated by Ségur de la santé. In Sight: Time-consuming formalities to be scrutinized by the “task force”.

Despite the fact that health issues are widely represented in the campaigns, some important topics have been left out. Laure Millet is in charge of the health program at the Montaigne Institute:

“There is little coverage of outpatient shifts and housekeeping in the programs, although these subjects are very important. The population is aging and most of them want to be cared for at home. So consolidating this household supply is a real challenge and it would ease the burden on the hospital. Some candidates approach this topic through their proposals for autonomy, but do not pay enough attention to it. The same goes for the figure that is mentioned in some programs, in particular telemedicine, but without a very clear measure in favor of investment in information systems and data collection in cities and hospitals.”

Stop medical deserts

Conversely, medical deserts are at the center of presidential debates. Over the years, they have expanded and now reach some urban centers. In the background, an insufficient number of trained medical practitioners (10,000 per year) and poor distribution across the territory with a large gap between the Center-Val-de-Loire and the PACA region.

The Numerus clausus has certainly been canceled during the last academic year, but it will take ten years to assess the consequences. In addition, financial incentives to practice in areas with limited resources do not work well.

Should we touch upon freedom of attitude, the totem of liberal medicine? Yannick Jadot (EELV) and Fabien Roussel (PCF) will clean up facilities in already well-endowed areas after the departure of another doctor, and the environmental candidate will commit “temporary and transitory” train in a sparsely populated area at the end of the internship and in the first years of the exercise.

Marine Le Pen (RN) will change the price depending on the location of the classes. Ann Hidalgo (PS) will train 15,000 new physicians per year, with one year as a general medicine internship assistant in under-resourced areas.

Valerie Pecresse will create junior doctor status, including an internship year in the latter (subject to price increases), and increase second-year medical enrollment to 20,000 per year. Nicolas Dupont-Aignan (DLF) will offer a scholarship to students who do not settle in the medical wilderness during their first five years of practice. Eric Zemmour (right) will hire 1,000 paid doctors in municipal and departmental centers.

Health Democracy

Some candidates suggest relying on other medical professionals. Jean-Luc Mélenchon (LFI) relies on paid nurses and midwives of excellence. He also wants “to pave the territory of multi-profile health resorts”, a track shared with Philippe Putou (NPA). Emmanuel Macron (LREM) will expand the use of paramedics and appoint pharmacists and nurses. “referents” competent in simple actions. He also mentions “Installation Schedule”while young people from resource-poor regions will receive support during their medical studies to encourage them to return to practice.

What if the solution to improve access to health care also involves greater community participation?

“The key word patient is mentioned in a large number of programs, but without a specific tool for involvement in the healthcare system, notes Laure Millet. Nearly 40% of French people have the impression that they live in a medical desert, but according to a study by Mutualité Française, only 10 to 12% actually live in areas that qualify as such, clearly showing a significant gap between perception and reality. .

The Montaigne Institute expert continues:

In part, this can be explained by a significant lack of information about the quality and relevance of medical care. For several years we have advocated for the creation of quality indicators developed jointly by patients and healthcare professionals. These indicators are a lever for reforming the financing of health care, guiding the health care system through quality, as well as for strengthening democracy in health care.”