“By focusing the spotlight on the hospital, we run the risk of missing out on the real issues”

NOTur public hospitals are facing major difficulties: the waves of the epidemic have exhausted the professionals of an already weakened public hospital, there is a shortage of nurses and disciplines such as emergencies, pediatrics and psychiatry are going through a difficult period. We devote our energy to seeking solutions and fixing problems, and therefore have no intention of minimizing these difficulties.

Nevertheless, the AP-HM provides high quality care to all without distinction, medical and paramedical education in our university hospitals remains of excellent quality and French medical research remains of a very high standard, thanks in particular to our university hospitals. Our hospitals therefore remain among the best in the world.

We are proud of our public hospital and want to warn: by focusing the spotlight on the hospital, we certainly detect all its difficulties, but we run the risk of only looking for solutions in this light and thus, of missing out on real stakes, even to destabilize what works without solving any problem.

The effective and complementary doctor-director pair

Thus, for almost twenty years, a first spotlight has been targeting hospital governance and the relations between directors and doctors, to the point of pushing corporatism on all sides to tear each other apart for nothing. And yet, the doctor-director duo seems effective and complementary to us. One is appointed, the other is elected; one has a background in medicine, the other in public health and management.

Our responsibilities complement each other, we act together and our subject is not to quibble about our respective powers but to implement our joint decisions to transform our hospitals as quickly as the challenges to be met require.

A second spotlight targets the financing of hospitals and the excesses of activity-based pricing. Funding reform is needed, but without avoiding other debates. First of all, our country is faced with the need to renew major post-war investments. Some hospitals, such as Marseille, require considerable investment, in particular to deal with the necessary reduction of the carbon footprint.

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Then, our country must stop tolerating the abundance of healthcare available in certain territories and the shortage elsewhere, the human and financial cost of one making it difficult to fight against medical deserts. It is necessary to adapt the financing of the public hospital but also to transform those of the hospitals and clinics which mobilize too many means in view of the service actually rendered.

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