Public health. The false good idea of ​​"care" of proximity

The Council of Ministers examines, this Wednesday, the law health containing part of the measures of the plan "My health 2022", presented by Emmanuel Macron on September 18th. In addition to the end of the numerus clausus and the reform of the competition of interns, the text to be presented to Parliament in mid-March, formalizes the label "local hospital". Invited on France Inter, yesterday morning, the Minister of Health explained "to commit so that every French finds a doctor and a professional offer of health close to his home". "We maintain a gateway nearby, local hostos will be reinvested financially, especially in geriatrics, (…) rehabilitation care, radiology, biology," promised Agnès Buzyn. Currently, 243 establishments are labeled "local hospital", the government intends to increase this figure to 600 while modifying the missions. Where and how ? Both of these issues raise serious concerns. Starting with the local elected officials who, in a joint statement of the Association of Mayors of France (AMF) and elected community in France, ask the government to hear "the call of the territories for a public health care offer preserved and developed "and" to stop any closure of public hospital services ".

Obstetric and surgical care excluded from local hospitals

The first reflections on the profile of the future local entities that filter ministerial authorities augur a serious decline in the size of some hospitals, particularly those providing obstetric and surgical care. And for good reason. These two specialties will be excluded from future local hospitals "not compatible with the HP model," according to a senior official of the Directorate General of Care Supply (DGOS). The new hospital card would therefore offer three levels of institutions: hospitals "of excellence" practicing advanced medicine. A little less distant: the referral hospitals allowed to offer medicine, obstetrics, surgery. And lastly, the local hospitals dedicated to the care of the elderly and the follow-up of the chronically ill. The latter will have to offer advanced consultations of specialties (except general medicine) in direct access or by telemedicine. Follow-up and Rehabilitation Care (SSR) and emergencies would be optional. "There will be no more hospitals. The overall strategy on a territory is to have a parent company which is the most important hospital, then subsidiaries that will be attached to it: the one that will do maternity, cardiology, hip prostheses. These subsidiaries will themselves be labeled. If one of them provides advanced surgery, it will be "specialized". If she does not, she may be a local hospital. In my opinion, all hospitals should be close, "said Philippe Batifoulier, health economist (see our interview opposite).

It is "a law that will promote access to care throughout France," says the Minister of Health. Examples in support, Hélène Derrien, the president of the National Coordination of the committees of defense of the hospitals and maternity of proximity, in doubt. In Concarneau (Finistère) where she lives, the hospital of the territory is only a shadow of itself. In this basin of 50,000 inhabitants, whose population doubles during the summer, the maternity and the surgical service closed their doors in 1992 and 1994. It ensued the fusion of the establishment with the hospital of Quimper in 2008. Last avatar, closing night emergencies. The first emergency service is now 45 kilometers "at risk of endangering the lives of others", alarmed Hélène Derrien. The Quimper follow-up care and rehabilitation service should in turn close its doors to be transferred to Concarneau, whose future of "specialized" establishment is all traced. "This hyperspecialization logic has nothing to do with a local hospital that meets the needs of the entire population. Especially since groupings and mergers always result in closures of services and beds. The proof by the numbers. According to the Department of Health Research, Studies and Evaluation, the number of public hospital sites fell by 7% in five years as a result of restructuring. As for maternity, half of them disappeared in twenty years. There are fewer than 500 today. Agnès Buzyn may say that "the maternities are not closed" since they are replaced by "perinatal centers of high quality" and explain that "the act of delivery is done in a specialized technical platform" women give birth more and more far from home.

The health law should be passed before the summer, but for missions and the list of local hospitals, a sensitive subject, the government has once again chosen the path of prescriptions. "They are not intended to prevent consultations, but orders are made necessary by the urgency of legislating on the end of the numerus clausus and the reform of competitions for medical studies," defends the cabinet of the minister. Not sure that this convinces Patrick Brouet, the president of the order of doctors who recently lambasted "the important use of prescriptions".

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