four years later, a “public health debt” in hospitals and “worrying disparities”

According to the first barometer from the French Hospital Federation (FHF), hospitals have regained their “overall” level of activity from 2019, but with worrying disparities depending on the sector. And access to care remains difficult.

According to a study by the French Hospital Federation (FHF), four years after the Covid-19 health crisis, the level of activity in 2023 has “overall, returned to the level observed in 2019”. The FHF, which presents this first major health barometer* on Monday March 17 in partnership with franceinfo, nevertheless underlines “worrying disparities” depending on the services. Thus, compared to projections made before Covid-19, this barometer measures, cumulatively, nearly 3.5 million canceled or postponed hospital stays between 2019 and the end of 2023. And Arnaud Robinet, president of the FHF, estimates on franceinfo that four years after the crisis, “nothing has been purged.”

The FHF evokes “the existence of a form of public health debt, that is to say of activity to be caught up or of lasting consequences on the state of health of the population of care provided late”. This deficit in hospital stays, or “sub-recourse”, shows worrying disparities. Medicine recorded a drop in the number of stays of around 433,000 compared to forecasts.

In detail, there was less support digestive diseases (-11%), cardiology (-13%), related to the nervous system (-11%), and rheumatology (-12%). Also falling in the number of endoscopies, 260,000 could not be carried out. Same observation for major surgeries with 600,000 fewer than expected. Transplants, for example, are down 7.5% compared to the level expected in 2023. This situation has consequences for the health of patients. The FHF cites in particular the “delay in the detection of certain cancers” or the “insufficient care for diabetics over 35”.

The recruitment of caregivers is struggling

Two explanations are put forward for this sub-recourse of going to hospital. First, the renunciation of care or the increase in delays in receiving care. “Between difficulty accessing care and economic difficulties, more than six in ten French people have already given up on at least one healthcare procedure over the last five years”, says the French Hospital Federation. For 50% of them, they gave up because the wait for an appointment was too long and for more than 40% it was because of financial difficulties.

Another possible explanation is the tensions experienced by the public hospital with occasional bed closures. In 2023, 70% of the hospitals that participated in the study closed beds in medicine, 29% in surgery, 25% in critical care and 17% in emergency rooms. Overall, 60% of closed beds are closed because hospitals are unable to recruit enough caregivers. Since 2020, certain medical practices have also changed. For procedures where it was sometimes necessary to be hospitalized for one or more days, patients now return home the same evening.

Strong disparities between rural and urban areas

The FHF barometer includes an opinion poll carried out by Ipsos, focused on access to and renunciation of care. This survey highlights the lack of access to care depending on the territory. “The time to access care for rural people generally remains 52% higher than that of urban people”. For example, it takes a 57-minute journey from home for a rural resident to access an ENT, compared to 32 minutes for an urban resident.

The FHF also emphasizes that in all territories combined “the waiting time to get an appointment has almost doubled in five years for the majority of specialties”. For example, the delay increases from four days in 2019 to ten days in 2024 for a general practitioner, or even more than a month in 2019 for a gynecologist compared to a two-month wait in 2024. The same goes for consulting a cardiologist.

This deterioration in the provision of care has consequences for emergencies. In 2024, 54% of French people say they have already gone to the emergency room for reasons that did not relate to a medical emergency, compared to 42% in 2019. Among the reasons given, 32% did not know who to contact in outside the hospital emergency department, 30% say it was impossible to get an appointment with a general practitioner or specialist within an acceptable time frame, 22% because the general practitioner or specialist refused to take walk-in charging. Distance is also an explanation: 18% say that the hospital emergency rooms are closer than the doctor who could take care of them. Finally, the cost is a barrier for 13% of respondents who cannot pay the costs of a consultation and therefore prefer emergencies.

Still according to the Ipsos survey for the FHF barometer, 63% of French people have already given up at least one act of care (consultation with a doctor, purchase of medication or medical analysis) in the last five years, for various reasons: it took too long to get an appointment (53%), this appointment was too far away (33%), or the care was too expensive (42%).

*Methodology: survey carried out online via the Ipsos Access Panel Online on a sample of 1,500 French people representative of the French population aged 18 and over from February 29 to March 6, 2024, using the quota method: gender, age, profession of the individual, category of agglomeration, region.