Ihe national debate on the end of life has left little room for reflection on the economic and financial realities of our care policy. In the name of freedom and equality, the participants in this reflection succumbed to oratory contests on the conquest of new individual rights, rather than thinking collectively about our health organization and its cost.
The work of the citizens’ convention, the assessment mission of the National Assembly or the opinion of the commission of the Economic, Social and Environmental Council have never put into perspective the problem of the end of life with the policy choices health of our country. Rightly, all have deplored the inadequacy of the palliative care offer, without much originality. Indeed, the shortcomings of the palliative care policy have been denounced regularly for fifteen years by Parliament, the Court of Auditors and the General Inspectorate of Social Affairs. Nor have the exploratory reports by Jean Leonetti or Didier Sicard enabled a significant correction of the trajectory, whereas the right to access to palliative care has been recognized by law since 1999. But it is true that the legislator has the unfortunate tendency to consider its mission accomplished once the law is enshrined in a text.
Admittedly, palliative care plans have succeeded one another, but the home supply remains insufficient and 21 departments still do not have palliative care units. Meanwhile, the aging of the population is accentuated, hospital structures are weakened, medical deserts constitute a sad reality and the discourse in favor of the legalization of euthanasia and assisted suicide is gaining ground. These two forms of administered death appear to be the only response to the inability to think about care or to develop a palliative culture that is nevertheless necessary for the needs of an aging society as well as those of vulnerable people.
We spend more but badly
According to the report of the Social Security Accounts Committee, health insurance expenditure amounted to 245 billion euros in 2022. Six billion euros would be spent during the end-of-life period, of which half in the last month. These expenses include so-called “expensive” drugs and devices. Some of these prescriptions stem from unreasonable obstinacy due to a lack of thoughtful consultation on the relevance of their indication. Expenditure on these expensive “curative” treatments has increased by 36.7% since 2015, i.e. three times more than the entire consumption of hospital care over the same period. Drowned in a sometimes useless expensive technicality, these expenses completely eclipse those, necessary, related to the relief of the symptoms and the logistics of the assistance to the autonomy which requires any person weakened by the disease, the old age or the handicap. We spend more but badly. In its 2022 report on the Social Security accounts, the Court of Auditors notes that “France is one of the European countries in which spending has increased the most and which has carried out the fewest structural reforms”.
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