NOTur healthcare system, we hear everywhere, is in crisis. But that’s incorrect. What is in crisis is not a health system, that is to say a system that addresses health in all its dimensions with the primary objective of avoiding disease, but a health care system. And, moreover, essentially based on medical care.
There are various historical reasons for this that have favored the biomedical model of health: victorious fight against infectious diseases, spectacular progress in instruments and imaging, ease of fee-for-service financing and activity-based pricing , weakness of the flat-rate approach or tariffs for prevention, adherence of doctors to a predictable source of income guaranteed by payment for acts, remuneration further guaranteed by the Malthusianism of training (the numerus clausus at work for almost half a century even if that was not its only goal), belief in the infinite progress of medicine and pharmacy as well as in the unlimited capacities of payment of our social insurances, dramatic abandonment of mental health , because it is not very accessible to the standardization of acts.
In short, a system that dates back and whose flaws, although congenital, have long been ignored: due to fee-for-service, increased competition instead of cooperation between health establishments among themselves and with the medicine of city ; maladjustment to the chronic and degenerative diseases that are dominant today; lack of resources for research; growing social and territorial inequalities; weak health in education; selfishness in the consumption of care and ignorance of the conditions of solidarity.
Operation in organ pipes
The situation is serious, and the crisis is signaled first of all by the worrying lack of doctors and nurses in the hospital as in the city. Specialties are affected: psychiatry, cardiology, rheumatology, gynecology, pediatrics and many others. Everywhere the delays for obtaining an appointment are getting longer… to six months, to a year… leading to dramatic situations and – this is beginning to be seriously documented – to a loss of chance of survival.
Add to this the difficulties of supplying certain widely used drugs. The crisis is deep, systemic, affecting all aspects of our healthcare system. This will not change tomorrow. Even if it were possible, it would take time. Suddenly, we realize that it wouldn’t be so bad to avoid needing care as much as possible by promoting health and well-being.
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