” And if we had to do it again ? Six former health ministers look back on twenty years of reforms
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“Our whole health system is at the end of its tether. » It was when he took office in July that the new Minister of Health and former head of emergencies at Metz-Thionville hospital, Francois Braun, made this alarmist observation. The shortage of doctors, nurses and nursing assistants has already caused, in the first days of summer, the closure or degraded operation of more than one hundred and twenty emergency services in the public sector.
To go back to the roots of this deep crisis of the hospital system, The world interviewed several of the health ministers who have succeeded each other over the past twenty years: Jean-François Mattei (2002-2004), Xavier Bertrand (2005-2007, then 2010-2012), Philippe Bas (a few months in 2007 , but also Minister Delegate for Social Security from 2005 to 2007), Roselyne Bachelot (2007-2010), Marisol Touraine (2012-2017) and Agnès Buzyn (2017-2020). We asked them, if they had to do it again, what reforms should have been undertaken or, on the contrary, amended, to avoid the current crisis. All have a critical look at the health policy undertaken since the turn of the 21st century.e century, but often less severe on their own Avenue de Ségur balance sheet.
The numerus clausus or the fall in the number of doctors
France estimated in the 1970s that it risked having too many doctors. A numerus clausus is then put in place to limit the number of students admitted to the second year of medicine, without any real assessment of health needs, on the assumption that the more doctors there are, the more prescribers there are. and the more the Social Security deficit grows. The medical world also sees its advantage in this: containing the number of practitioners makes it possible to limit competition and guarantee income. The measure logically led to a collapse in the number of doctors trained, with a decrease of nearly 60% in the mid-1990s.
“When I came to the ministry in 2017says the former Minister of Health Agnès Buzyn, I knew the healthcare system was under strain. The first thing I asked my teams was to show me the population projections. When I saw the curves, I freaked out. I saw that the projected retirements of physicians trained in the 1970s and the number of physicians trained made a V curve in the next ten years. We had no way of maintaining the same number of doctors – already insufficient in 2017 – on the territory. »
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