For this debrief of the issue of “Cash Investigation” titled “Freedom, health, inequalities!” (replay), Elise Lucet is surrounded by Gabriel Garcia, who carried out the survey, the data specialist Julien Beccu, and of Sophie Le Gall to the editor-in-chief.
Quentin (Loire) > I am a young general practitioner, I have just started (by choice!) in an under-resourced city. I don’t think coercion for coercion’s sake is the right solution.
Elise Lucet > No one asks coercion for coercion. It is rather a framework of freedom of installation, as in Quebec, for young doctors. With both financial incentives if they settle in areas that lack practitioners, and financial penalties if they do not respect the installation rules. And it is limited in time since it only lasts three years.
> And in France, what do we offer?
Gabriel Garcia > In France, take the proposal of the Court of Auditors, for example. It does not call into question the freedom of installation, doctors can always settle where they want. On the other hand, the Court of Auditors proposes to no longer reimburse the consultations of young doctors who would settle outside medical deserts. This is called “deconvention”.
Raphaël (medical student – Lille) > I note with amazement that you never mention the numerus clausus, which has created in recent decades a shortage of doctors that extends throughout the country.
Sophie Le Gall > We would actually have liked to talk about the numerus clausus with the Minister of Health, Olivier Véran, since it was under Emmanuel Macron’s five-year term that it was abolished. Unfortunately, the minister refused to speak in “Cash Investigation”.
> What is the numerus clausus?
Sophie Le Gall > This term designates the maximum number of students accepted for the medical competition. And what is surprising is that it was set up in the 1970s, at the request of doctors’ unions, who then wanted to limit the number of practitioners. This measure also had an advantage for the public authorities: limiting the increase in health expenditure. In short, at the time, it suited everyone.
> What does the removal of the numerus clausus change?
Gabriel Garcia > In fact, since the abolition of the numerus clausus, which is very recent, there are more students enrolled in medicine. But these studies being very long, patients will only be able to measure its effects in about fifteen years. This is the average time between the start of studies and the installation of a doctor. Patients will therefore have to be… patient.
Florian (Nantes) > The director of the Flers hospital explains that there have never been as many doctors in France as there are today… I don’t know where he read that.
Elise Lucet > The director of the Flers hospital is right. There are indeed more and more doctors in France. Look at the evolution between 2012 and 2021: we go from 215,930 doctors to 227,946. So there is definitely an increase. Let us now analyze these figures more precisely. Still over the same period, the number of specialists increased sharply and went from 114,495 to 127,325. more attracted by specialties than by general medicine.
Roman (Puy-de-Dôme) > Is there a bill to limit or even eliminate medical deserts?
Gabriel Garcia > Yes, a bill will be debated next week in the National Assembly. It is the socialist deputy Guillaume Garot who is at the origin. The text proposes in particular to establish for all young doctors, whatever their specialty, the obligation to settle for three years in medical deserts. And even before its discussion, the debate is lively.
Louise (Bouches-du-Rhône) > Is freedom of settlement a French specificity?
Sophie Le Gall > No, freedom of settlement is a concept that exists in many countries, but to varying degrees. It is sometimes total, as in France, or more framed, as in Quebec.
> You talk a lot about Quebec, but are there other examples?
Elise Lucet > Yes, there is Germany. There, a doctor is only allowed to set up in areas where needs have been identified. There is even a threshold beyond which there can be no new installations. If a doctor decides to settle down despite everything, he is no longer under agreement, that is to say that his consultation is no longer reimbursed by health insurance.
Doudou 31 (Haute-Garonne) > You are talking about clinics and hospitals that operated on gynecological cancers without authorization between 2016 and 2018. Is this still the case today?
Gabriel Garcia > If we cover the period 2016-2018, it is because we launched our requests for access to health data at the end of 2019: “Cash” investigations take time… The most recent data then dated from 2018 To answer precisely, it is very likely that hospitals and clinics will continue to operate without authorization. No sanction was applied. The amendment that Olivier Véran voted when he was a deputy remained a dead letter.
> And if we want to know where to have surgery today?
Julien Beccu > If you want to know the establishments authorized to perform cancer surgeries, you can go to the Franceinfo.fr website. We have posted the list of hospitals and clinics that are authorized to operate, for all types of cancer. This information is very recent, it dates from 2021. These are data provided by the National Cancer Institute (INCa).
Jean-Jacques (Moselle) > You are not talking about home dialysis, when it offers many advantages to patients and is less expensive for health insurance…
Elise Lucet > Home dialysis concerns only 3,300 patients out of 48,000 on dialysis. Yet you are right, it has many advantages. Instead of traveling to a center three times a week for four hours of dialysis, which is very tiring, the patient can do two-hour sessions at home whenever he wishes. Peritoneal dialysis at home, for example, costs less for Social Security: 31,000 euros per year and per patient compared to 62,000 euros in a centre. But obviously, it’s much less profitable for the clinics.
Excerpt from “Freedom, health, inequalities!”, an investigation by Gabriel Garcia and Julien Beccu, broadcast Thursday January 13, 2022 at 9:10 p.m. on France 2.
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