a crisis that comes from afar

Like a ” elastic “ : you can shoot it over and over, but when you reach the breaking point, it’s too late. The pictorial version, in the mouth of a doctor, of “Collapse” of the public hospital tells the feeling of part of the healthcare community. We have been pulling on the “rubber band” in the hospital for a long time. In the spotlight since the surge of the Covid-19 epidemic in March 2020, health establishments have been put to the test by two years of standing on the “front line” to take care of patients with the virus. But the crisis has only accentuated, or given to see to the greatest number, ailments already present, we keep repeating in the ranks of caregivers.

How did we come to have to close “Beds” in many departments at the start of the school year, certainly in a climate of calm on the Covid-19 front? And, everything except by choice, but for lack of finding the nursing staff. How has the hospital lost its appeal to such an extent, taking the full brunt of the departures and absenteeism of paramedical personnel, especially nurses? Not to mention the increasingly significant shortage of doctors, forcing emergency services to close in dotted lines …

T2A for “activity-based pricing”, Ondam for “national health insurance spending target”, HPST for “hospital, patients, health and territories” law… Reviewing the film of twenty years of reforms allows us to understand, in part, the current crisis. And the insufficiency of a large-scale plan launched in the summer of 2020: the Ségur for health, with its envelopes of around 10 billion euros for salary increases, or 19 billion euros for investment.

  • A slow budgetary asphyxiation

If one had to find a culprit that is unanimous in the hospital ranks, among doctors and administrators, it is the budget. The hated acronym of Ondam has become synonymous with the slow cure of austerity imposed by the state on health establishments. The senior official Pierre-Louis Bras, a fine connoisseur of the hospital world (former director of Social Security) and author, in March, of a note for the Terra Nova think tank questioning the regulation of health spending, says it simply: “We went well beyond what was sustainable. Hospital policy has been above all a public finance policy for twenty years: it is about reducing the debt and the deficit, without increasing taxes. “

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