Hospital crisis: “We are in a structural crisis”, analyses the founding president of the Health Institute

For Frédéric Bizard, professor of economics at ESCP Business School and founding president of the Institut Santé, it is necessary to “bring life and modernity back” into the rules of the public hospital.

“We are in a structural crisis which, for emergencies, is linked to factors internal to the hospital”analysis Wednesday August 21 on franceinfo Frédéric Bizard, professor of economics at ESCP Business School, founding president of the Health Institute. “All hospitals are under pressure […] The public hospital must realize that it has an internal crisis and a problem of attractiveness”continues the professor who hopes for a “equity of public-private treatment, but also equivalent rights and duties.”

Frédéric Bizard reacts to the fact that emergency rooms are under pressure this summer, with partial or total closures of services, as well as long waiting times. The resigning Minister Delegate for Health, Frédéric Valletoux, stated on Tuesday that emergency rooms in“about fifty hospitals” French “are currently under tension” due to lack of staff. On Wednesday, Jean-Luc Jouve, president of the Medical Commission of the University Hospitals of Marseille, pointed the finger at private doctors on franceinfo: “The real problem is that there is no participation of private medicine and private clinics in the continuity of care”. Comments that Agnès Giannotti, president of the leading general practitioners’ union MG France, opposes, assuring “be there”.

franceinfo: What is your opinion on the matter?

Frederic Bizard : It is very sterile to oppose the public and the private in a systemic, therefore structural, crisis. Health resources have not decreased, we are at 12 points of GDP compared to three points 50 years ago, so it has not stopped increasing. Resources increase by approximately 3% per year. But what is true is that we are in a structural crisis which, for emergencies, is linked to factors internal to the hospital. All hospitals are under pressure. When you close an emergency department at night, it is the emergency department next door that ends up with more patients.

“The public hospital must realize that it has an internal crisis and a problem of attractiveness.”

Frédéric Bizard, founding president of the Health Institute

to franceinfo

It is governed today by rules that date back to 1958 and the Debré ordinances, with full-time hospital work, with great rigidity in career management. We need to breathe new life and modernity into all of this. What is true is that we also need to extend public service outside of the hospital, to all stakeholders. Functions such as on-call care must be mandatory for all public and private stakeholders, financed by Social Security.

I think that we need fairness in public-private treatment, but also equivalent rights and duties. That’s how our health system was designed, it’s a hybrid public-private. The public has specificities in terms of research, training, etc. But for the bulk of care, we need this fairness.

What do you mean by less rigidity in the hospital? ?

Today, you are forced to work full-time at the hospital. However, there are many young people who want to work three days a week at the hospital and two days in the territories or on another project outside the hospital. We need to provide flexibility. Another thing is that the promotion system at the hospital is extremely rigid, it is very complicated for a nursing assistant to become a nurse and it is complicated for a nurse to become a manager and have management responsibilities. Covid arrived and made people realize that the balance between professional and private life is very important.

“We can no longer manage healthcare staff as we did in the 20th century, and that’s what we’re doing with public hospitals.”

Frederic Bizard

to franceinfo

You say health care costs are increasing, where is the money going?

It feels a bit like a Danaïdes barrel. For example, the government under Macron went from 100 to 120 billion euros in hospital spending. That’s not nothing. We’ve never made such a budgetary effort since 2020. However, caregivers have the impression of not seeing any of it. Why? In France, caregivers, like teachers, are poorly paid, so when you give them a 200 euro raise, they don’t feel like it’s going to change their lives. All of this has to be part of a set of measures that improve working conditions in the broad sense. It’s not just a financial issue. Caregivers demand to be in a framework that recognizes their value, their expertise.