Tribune. The public hospital is suffering, and the health crisis linked to the Covid-19 pandemic has only worsened the situation. Beyond the emergency plan for the hospital, presented in November 2019, or the 33 measures of the Ségur de la santé in July 2020, government responses still appear too often calibrated according to a Jacobin vision of the health system, without consideration. the real heterogeneity of French territories, both in terms of the health of the population and in the organization of the healthcare offer.
In France, while six out of ten hospitals are in deficit, the 1,300 public establishments listed over there Department of research, studies, evaluation and statistics, in 2017, differentiated themselves by their missions, providing more or less specialized care in short or long stays, but also by their location, from the CHU to the small local hospital. In addition, there are private establishments, of varying sizes and specialties, in particular more than 1,000 clinics, which each year perform nearly two-thirds of outpatient surgery procedures. However, each territory differs by its geographical, demographic, social and epidemiological characteristics, making it necessary to take careful account of these specificities and associated needs.
While the requirement of the relevance of care is reaffirmed, aimed at reducing the time taken to take charge, unnecessary medical acts or non-compliance with prescriptions, the question of medical deserts and the equality of Health care access. In rural areas, local hospitals are struggling for their survival in a context of stagnation, or even decline in the population served, its aging and the difficulty of keeping services open for lack of doctors.
Regional agencies struggling
By developing, within a given territory, a collective medico-nursing strategy between health establishments, the territorial hospital groups (GHT) are part of this search for adaptation to local characteristics. But their implementation is proving to be slow and complex, especially as private establishments are not very involved, thus confirming that other avenues must be explored.
At the regional level, the regional health agencies (ARS) are responsible for steering the health system, defining and implementing regional health policy, as close as possible to the needs of the local population and its specificities. Captured by the creation of GHTs and professional communities of health territories (CPTS), in a context of widening their scope of action linked to new regions, the ARS today seem to be struggling.
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