2024-02-05 11:05:21
Health system: how did we get here? How to cure it ? Isn’t the major problem the gap that exists between public authorities and caregivers? Former Ministers of Health Claude Evin, Roselyne Bachelot, Agnès Buzyn and François Braun took part in the question-and-answer game in the Counterpoints of Health on January 31. Synthesis.
Invited by Philippe Leduc, Pascal Maurel and our director Renaud Degas, the four former ministers looked at the “health” of the French health system, four years after the start of the Covid crisis. So, what diagnosis? What analysis? What feeling ?
“The health system is constantly reforming”
As an answer, Claude Evin wanted to put things into perspective. For the former Minister of Social Affairs and Solidarity (May 1988 – May 1991), the health system is in « tension » perpetual between “the demand for care and the capacity to respond to it”although currently exacerbated by the problem of medical demographics and the rise of chronic diseases. “Let’s get out of the mindset that we are in a completely fixed system,” he urged.
This does not necessarily ” fast enough ” more “the health system is constantly reforming” under the effect of new therapies and new healthcare organizations. So much so that today, “we are treating a certain number of pathologies better and better”. And despite “a real problem of access to primary care, linked to a failing territorial organization”We have “still overall a health system that responds to issues that we did not respond to 20 or 30 years ago.”
The question nevertheless arises of ensuring “control and distribution of resources” between the actors, he estimated. Resources which this year exceed 250 billion euros.
“Infinite demands for care in a system with finite resources”
Roselyne Bachelot she deplored “the incurable drama of the ministers’ waltz” of Health which prevents the success of any reform. She also said “struck to note that during health system reforms, the responses are often quantitative”… instead of being “qualitative”, adapted to changes in lifestyles, the aging of the population and “ to the fall of family solidarity”. France is the “country in Europe where the most people die in hospital”, she slipped.
The former Minister of Health and Sports (May 2007 – November 2010) and former Minister of Solidarity and Social Cohesion (November 2010 – May 2012) also warned about “the major transformations that are going through our society with an infinite demand for care in a system with finite resources”. Syears to count, “with Covid, the rise of conspiracies, alternative medicine”, the “desire of all to leave the healthcare system” and or “to have another offer”, such as a “very very specialized maternity request” or less medicalized… There is, according to her, “extremely diverse and extremely difficult demands to integrate into our system”.
Finally, “heavy consumers of care, particularly the elderly, are today those who contribute the least to the financing of health insurance. There are perhaps things to rethink there.” among which, a CSG ” at the same level “ for retirees as well as for workers, she suggested.
“An international problem”
“Change in the epidemiology of diseases, demographic change, longer lifespan, lack of caregivers…”the upheavals are profound and global, pointed out Agnès Buzyn. Il “There is currently a shortage of 18 million caregivers in the world, there may be a shortage of up to 30 million in 2050”. She therefore called, unsurprisingly, to “more primary care, less hospital-centrism…”. Il “society must also look at itself in the way it consumes care, in the way it supports old age” et “do not imagine that a minister will have a miracle solution for a transformation over 40 or 50 years”.
” We let’s build, brick by brick, improvements, continued the former Minister of Solidarity and Health (May 2017 – May 2020). I think that we are at the bottom of the wave but that it will start to improve, because we have made structuring reforms to move towards more primary care, (…) that the number of specialists increases… The number of generalists will rather increase from the 2030s but we created the IPAs, we created the CPTS to have a population-based vision of care… there are a lot of reforms to restore medical time…”
To go further, two other areas of work seem essential to him: the relevance of care – while there is “15 to 20% of unnecessary actions” – and the need for an interministerial policy on prevention.
“Health cannot be reformed in a year”
“We have built health systems on the provision of care to cover the health needs of the population; the problem is that needs have increased and supply has decreased, not necessarily in number but in available care time and available medical time”for his part, summarized Francois Braun. Result : “we must rethink and evolve our health system towards one that meets the health needs of the population; It is in this spirit that we have set up the National Health Refoundation Council (CNR) with discussions territory by territory, for solutions territory by territory”.
The one who was Minister of Health and Prevention (July 2022 – July 2023) also judged “absurd to re-discuss health policy every year within the framework of the PLFSS” and called for a “health programming law over several years”.
Other issues: stop “hospital-bashing”, strengthen public-private cooperation and improve the daily lives of professionals. In the hospital, for example, “Ségur de la Santé has made it possible to increase salaries” But this is not enough : “Above all, we must provide better working conditions, much more flexible management at establishment level, return to the service level”. And to conclude: “we have turned the earth, sown it, we have to wait a little for it to grow before we can harvest.”
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