Guards, freedom of installation: liberal doctors asked to carry more “the burden of the general interest”

“This is the five-year last chance for the health system”. After eleven years at the head of the French Hospital Federation (FHF) representing public hospitals, Frédéric Valletoux does not take gloves. In his eyes, without rapid “fundamental reform”, it will be the end of the “health system as we have known it”.

Faced with shortages of medical personnel, the government this summer adopted a series of emergency measures to help hospitals. However, “none of the ills of the hospital and the health system found a structuring response during the summer”, estimates Frédéric Valletoux. Now deputy of the presidential majority (Horizons), he will leave the presidency of the FHF at the end of September.

Endless dialogues

The subject of health is on the menu of the kick-off meeting of the National Refoundation Council (CNR) scheduled for next week and must be the subject of a “stakeholders’ conference”. With a consultation between all the actors at the national level, as well as a “citizen consultation”, has already indicated the Minister of Health and Prevention, François Braun.

“My fear is that the conference of stakeholders will relaunch endless dialogues. We have been piling up reports and consultations for fifteen years, ”says Frédéric Valletoux. The elected representative of Seine-et-Marne recommends adopting the “Ségur method” the salary increase plan for medical staff adopted in July 2020, after a few weeks of negotiations.

According to the former mayor of Fontainebleau, “for ten years, we have avoided fundamental reforms a lot”. Without making the professions of caregivers, which are essential to cope with the aging of the population, attractive enough. To achieve this, the president of the FHF believes that it is necessary to rebalance the sharing of public interest missions between the hospital and a liberal medicine “which bears less and less the burden of the general interest”.

“Be a little more coercive”

“Gradually, we lifted the constraints for the liberals – for example by removing the guards, explains the elected official, while they are doctors “financed by public money”. At the same time, the hospital has become an “over-administered system”. “It is on the back of the hospital that we have accumulated a certain number of constraints”. Especially to save money.

Admittedly, the picture is “not black and white”, recognizes the former journalist citing the 40% or so of general practitioners who participate in the permanence of care. We still need to expand their number.

To do this, “everything that is an incentive mechanism does not work”, assures the elected official. “We can no longer do without being a little more coercive, even if there can be plenty of degrees of requirements”. And to mention, for example, the supervision, or even the prohibition, of excess fees for doctors working in areas already “over-endowed” with practitioners.

“Unnecessary spending”

What bristle number of liberal doctors, very attached to the principle of freedom of installation. “There are liberal unions which, rather than proposing solutions, are braced so that nothing changes”, annoys Frédéric Valletoux. However, the emergency room crisis has pushed Liberals and Hospitallers to form a common front.

Beyond these debates, the question of financing should be tackled. “Our health system produces unnecessary expenses. However, if we want to improve the salary of the nursing assistant and the consultation of the general practitioner in sector 1 (without exceeding fees), this is where the sources of savings are, ”continues the parliamentarian.

“Sobriety in action”

Among these expenditures to be eliminated, which would represent up to 30% of total health expenditure, he recommends tackling in particular “unnecessary acts which do not serve the general interest in health”, such as redundant acts or ” acts of financial comfort for professionals”. The FHF has produced studies in the past showing that private clinics and hospitals perform more caesarean sections.

“We need sobriety in actions”, summarizes the deputy, echoing the calls of the executive to prepare in full energy crisis “the end of abundance” .

Behind this “hunt for useless acts”, it is the remuneration grid for acts that must be dissected in addition to the management of the financing of the health system by envelopes (the Ondam) that it would be important to review according to Frédéric Valletoux .

The spokesperson for public hospitals also recommends giving air to the actors by leaving a “steering which is only from the Ministry of Health”. The objective is in particular to move to a health system based more on prevention while it is “too turned towards the curative”.