The Public Hospital is Ill: Diagnosis and Treatment Hospitals save lives, let’s save them too! Publication date : October 26, 2022
André Grimaldi is Professor Emeritus of Diabetology at the Pitié-Salpêtrière hospital in Paris and the co-founder of Collectif Inter-Hôpitaux. He is the co-author of Santé : urgence, La Vérité sur vos medicaments, Maladies Chroniques. Vers la troisième médecine and Manifeste pour une santé égalitaire et solidaire.
The new French government has announced that health (hospital reform, in particular) will be a priority over the next five years.
But before treating an illness, you need to properly diagnose it. Hospitals have been suffering from three diseases, with cumulative effects: a lack of general practitioners in towns and the countryside, the consequences of the 1958 hospital reform and the subsequent 15 years of policies aimed at transforming the public hospital into a business with budget constraints.
Certain measures must be taken to prevent the collapse of the health system and to prepare us for the next health crises, based on three principles:
First principle: the creation of a town/hospital public service, including public and private non-profit establishments that are part of the public service, and general practitioner “Secteur 1” surgeries (fixed fees) that don’t charge extra. “Secteur 2” (variable fees) and private for-profit establishments are not part of the public service. The public health service should be decentralised and co-managed by the government, professionals, user representatives and local authorities.
Second principle: “Fair care for patients at the lowest cost to the community”. This principle should be applied to three areas: 1) merging of additional health care covers with the social security system, thus saving several billion euros in management costs. 2) Cost transparency in health industries, the end of sales visits, the construction of a public establishment, national or preferably European / multinational, if possible, for the supply of generic drugs of major therapeutic value, the financing of independent studies known as real-world studies. 3) The relevance of certain prescriptions and procedures, bearing in mind that 20 to 30% are unnecessary.
Third principle: a distinction in the financing and organisation of 4 types of medicine: medicine for benign acute illnesses, serious acute illnesses and complex technical procedures, chronic illnesses which are each individual’s responsibility and finally public health, which focuses on preventing and fighting social health inequalities.
These principles must be rolled out in 10 tangible, well-planned and funded measures over the next five years.