Three weeks ago, the bill “Garot” called So, transported by the deputy of PS of Mayenne Guillaume Garot, was adopted in the first reading in the assembly. It plans to supervise the installation of doctors, fight against medical deserts, demanding the departure of a doctor to authorize the installation of another, in “overdictable” areas.
The law is not adopted and continues its path between the two parliamentary chambers; At the same time, the profession continues to mobilize to reject any reform in this direction, considered ineffective. And in a note published Monday by Terra Nova, a circle of reflection marked in the center-left, the general director of Public-Hospital-Hospital of Paris (AP-HP), Nicolas Revel, made his contribution to the debate.
The high operation goes beyond the measures proposed by article 1 of the Garot PPL, against which the Government has already issued an unfavorable opinion, and wishes mandatory consultations in medical deserts, for all doctors who wish to practice excess rates.
Increase the number of professionals
Nicolas Revel first evokes a “need to increase the number of professionals in practice”, even expanding the question beyond doctors alone. “Today there are many health professions that really listen, in very extensive parts of the territory, even in the heart of the Paris region, but also in many medical specialties,” he supports.
But before this observation, develop a list of three errors to avoid. First, concentrate only in the initial training, while the famous numberus closus has risen to train more doctors. He warns: the objective of training 16,000 new doctors per year is equivalent to forming one in 50 young people, a high figure, although we do not know the needs of doctors within 30 years. Therefore, it favors the massive use of alternation and complementary training, so that caregivers develop new skills, “without necessarily having completely interrupted their activity, in an already advanced stage of their trip.”
Another error according to him, to forget that doctors and caregivers are today more mobile and more demanding in their working conditions: therefore, it is necessary to “make them want to choose this career, in the trades and structures where our needs are found,” says Nicolas Revel.
What leads to your main recommendation: you must regulate the place where doctors work, but also the specialties they can choose.
“The status quo is no longer possible because the tendency to concentrate facilities in large urban centers will be exercised in a sustainable and powerful way, especially for specialized doctors, due to both the economic one (possibility of rates overload), aspiration (aspiration to mixed-hospital and sociological exercises (use of the spouse, quality of life, etc.).
However, it rejects the limitation of the installation provided for in the Garot Law: and for a good reason, it emphasizes that it would be equivalent to transferring doctors to the percentage of large over -edotic cities, and without a real impact on medical deserts.
Therefore, it formulates a simple proposal: combine the restriction in the facilities and that in the specialties, especially for doctors in sector 2 that practice exceeding rates.
He is no longer managing health
This abrasive proposal is accompanied by a detailed analysis of the situation of public finances, and in particular the branch of social security disease. Nicolas Revel recalls that expenses accelerate at more than 4% per year, although the system is only sustainable below 2.5%. The deficit, of 13.8 billion euros in 2024, is no longer circumstantial, but structural, increases according to it due to salary increases, almost 14 billion euros per year, assigned to caregivers during health insurance.
Based on the principle that the deficit cannot continue, and that it is illusory to think that we can increase taxes (CSG in particular) or contributions to finance it, it also believes that it is necessary to review the financial management of care. This has been involved in recent years to reduce the financing of care acts, lower reimbursement rates or exclude attention for reimbursement. So many “legitimate” tools, but reached the end of their efficiency.
Above all, he invites you to play at the request of care, remembering that from 20 to 30% of health expenses are in the context of avoidable care. Then several measures are necessary: a better evaluation of the quality of care, and not its only amount; the group of hospital services in large structures; Complete doctors and hospitals based on achieving health objectives, not financial objectives.
Nicolas Revel finally evokes the need to invest in forecast, to limit the demand for attention: remember that France consumes more tobacco than the average, that we vaccinate less when vaccines are mandatory or that we cut cancers less well.
Above all, the management of chronic pathologies is missing and brings additional expenses: half of patients with heart problems, for example, did not receive optimal treatment at the time of crises, which generate a degradation of their health and additional costs for the community.
Source: BFM TV
