“We are up against the wall” to overhaul the health system in France, “come to the end of the race”, estimated on franceinfo Sunday January 16 Frédéric Valletoux. “The next five-year term is important” to consider an overhaul of it, also judged the president of the Hospital Federation of France. This federation, together with 54 other organizations representing the hospital, liberal and medico-social sectors, calls in an open letter published by The Sunday newspaper (JDD) to a debate on the future of the health system between the candidates for the presidential election, on March 17, two years to the day after the entry into force of the first confinement because of the Covid-19 in France.
franceinfo: Why are you calling for an overhaul of the health system?
Frederic Valletoux: The system has really come to an end. We have been accumulating reports and observations on the crisis in the health care system for about ten years. This epidemic, which has been affecting us for almost two years, has hit the health system, which was extremely divided and fragmented by numerous dysfunctions. We know very well that if France wants to keep a health system which retains its ability to take care of all French people, which offers the same access to care throughout the territory, a fundamental overhaul is necessary. Medical deserts are a subject that dates back ten years. We have a new window of opportunity with this presidential election and this new five-year term that is opening up. If health is not a priority during this one, then we will have a definitively weakened health system, with no doubt another system to be built.
Does the Ségur de la santé launched in 2020 not respond to this problem?
It was a recognition of the nation to caregivers and therefore an improvement in remuneration. The subject has been dealt with since nearly 9 billion euros have been put on the table to improve the remuneration of caregivers, especially in hospitals. But improving remuneration does not solve the problems of our health system: the question of medical deserts, the equal installation of general practitioners throughout the territory, the crisis in city medicine, the difficulties of the hospital, difficulties in financing the entire system… All these fundamental questions are structural questions, which will have to be addressed. Otherwise, we will have a health system that will continue to be weakened and above all caregivers who will leave it. Today, we still have a paradox: we have never had so many doctors registered with the Order of Physicians, and yet the French have never had so much difficulty finding an appointment and having a quality service in medicine, that is to say proximity. There are paradoxes to deal with.
Is it up to hospitals to take this type of initiative?
Normally no. But the hospital crisis is also about all the dysfunctions of the health system. I take two examples. First, that on the elderly and what is called the health course. Normally, you go to the hospital when you need critical care, that is to say a heavy act. You come for immediate care and then you are sent to follow-up care structures or, depending on your age, to institutions for the elderly. But this fluidity of the course is bad. A second example is emergencies. There has been a ten-year jump in emergency room attendance. It is also the reflection of a deep crisis in city medicine and the fact that the French have fewer and fewer general practitioners.
What do you think this overhaul of the health system should look like?
We will have to tackle the fundamental problems that have been known for a long time, but which have not been addressed. Funding, setting up, bringing younger generations back to the care professions. There are 100,000 people missing from nursing homes. If we don’t find any in the next five years, we will have degraded service. We have deadlines coming up, we are up against the wall. Either we manage to overcome the reluctance, or we let the system fall apart. The next five years are important. On March 17, we will be two years from the first confinement, it is an anniversary day. We will also be a few days away from the first round of the presidential election. This is decisive for the political debate in the noble sense of the term. All the candidates will come to express themselves on a subject which, until now, during the previous presidential elections, was a little passed under the bushel. It has obviously acquired a major acuity given this crisis that we know.