These first-line local structures have been waiting for more than a year for the funding promised by the government. The situation is denounced by four federations in a press release published on Wednesday February 8.
“If the state does not keep its promises, the center will be closed by July 1“, explains Vincent Clochard in a flat voice. The director of a nursing health center (CSI) in Châtellerault (Vienne) intends to seek legal redress by the end of the week. If the structure closed, 350 patients could find themselves without care overnight.
The situation is denounced by four federations (Adédom, Una, ADMR, C3SI) in a press release published on Wednesday February 8. They represent 300 CSIs (60% of the number of centers in France), or some 4,000 employees. They recall the existence of an amendment which entered into force in October 2021, and signed by the government and the social partners. This provided for a salary increase of 15% on average in the associative branch of home help, explains to franceinfo Hugues Vidor, director general of Adédom. “The expected public funding does not reach them”write the federations, the CSIs have been forced to “draw on their own funds to raise salaries“.
These non-profit structures are financed by health insurance on the basis of the number of procedures performed. They provide care at home without exceeding fees and without advance payment, and regularly carry out prevention campaigns. The CSIs are particularly present in medical deserts and priority neighborhoods, where the financial resources of patients are limited. In addition, they ensure a permanent presence within the center every day of the year, offering continuity of care to patients.
An additional cost of 90,000 euros in a center in Ardèche
Alexis Marthouret runs a nursing health center in Satillieu (Ardèche), where there are three doctors per 1,000 inhabitants. With a budget deficit of around 40,000 euros for 2022, the association expects to go out of business before the end of the year.
For Vincent Clochard, the increase in salaries on own funds generated an additional cost of 90,000 euros the same year for the CSI of Châtellerault: “We should have three months’ salary in advance, we are at 0, he is alarmed. We have more equity, we have nothing.” The two directors share the same fear: that of leaving a hole in the racket in access to care, in the midst of a public hospital crisis.
No response from Matignon for a year
The federations demand that “public authorities improve the financing circuit” And “are working on a clarification of the earmarking of funds“. Ronan Eliot, Director General of the National Confederation of Health Centers (C3SI), deplores an imbalance between the revalued wage costs, for acts whose rates have not increased for ten years. He calls on the government to “sit around the table” and rethink the business model of CSIs.
Contacted by franceinfo, the Ministry of Health explains that it has “entrusted a mission to the General Inspectorate of Social Affairs on this subject“, and affirms that she leads”regular discussions with these federations” in order to investigate their proposals. Emergency aid of 4 million was granted to the government in February 2022, via the Regional Intervention Fund (FIR). It is considered insufficient by the federations, which estimate at 11 million the annual budget necessary to compensate “funds advanced by associations“.
The director general of Adédom, asks for a new effort at the height of endorsement 43 approved by the government. “Health actors want a shift towards the home, and we are not meeting the needs of those who make”, emphasizes Hugues Vidor. According Ronan Eliotbetween 80 and 90% of the acts carried out by the staff of nursing health centers are carried out in the patient’s home.
The Ministry of Health says that “the advisability of paying aid in 2023 is the subject of an instruction by the services of the ministries concerned. Despite these promises, many nursing health centers are worried about their short-term future. “Everyone tells us they won’t last more than six months, says Hugues Vidor. It will already be too late.”