En deciding to present his wishes to health actors, a first since his arrival at the Elysee Palace in 2017, Emmanuel Macron avoided the pitfall of the agreed exercise and vague resolutions steeped in goodwill. Faced with an unprecedented crisis in the sector, the Head of State took the floor on Friday January 6 to finally give precise guidelines and a timetable that commits the government, even if the modus operandi remains to be clarified.
The situation demands it. For several years now, crises have followed crises. Tension continues to mount in all sectors of health. The hospital is close to the breaking point, the medical deserts extend month after month, the health professionals are in lack of recognition and in a state of advanced exhaustion. The vocations crisis is growing, only worsening the personnel shortages, which were already evident. Finally, the French are beginning to doubt a system that has long been presented as the best in the world, but which is now only a shadow of itself.
The Covid pandemic has only revealed dysfunctions that have been ignored for too long and bad choices dictated by the desire to curb the supply of care for reasons of savings, when it should have been adapted to a demand which was exploding, in particular due to the aging of the population and the development of chronic diseases.
The “My health 2022” plan, with the abolition of the numerus clausus, which capped the number of medical students, the Ségur de la santé, committing, a year later, 12 billion euros annually to better pay caregivers, were presented as the promise of a refoundation. In reality, they were only bandages on a system that must be rebuilt from top to bottom. The project will be all the longer and more difficult as it does not depend solely on budgetary envelopes. To attract caregivers again, a profound reorganization is needed, which involves changes in governance as well as a new approach to professions and working conditions.
Accept improvisation
From this point of view, the proposals put forward by the Head of State go in the right direction. Beyond the means, the hospital needs to extract itself from administrative contingencies, it needs flexibility in the organization of working time, and to restore power to the medical profession. It was time for these demands to be taken into account, as was the abolition of the fee-for-service pricing method, which created a disturbing race for profitability for the supply of care and for the management of establishments.
As for city medicine, medical deserts will not disappear overnight. While waiting to train the practitioners of tomorrow, we must accept improvisation. Coercion having little chance of being accepted in the current climate of tension, the executive is right to bet on the incentive, by proposing to better remunerate doctors who are ready to ensure more call duty or to take charge of new patients. The recruitment of 10,000 medical assistants, who will allow practitioners to offload administrative tasks to devote more time to patients, is also welcome.
If the diagnosis is good, nothing says that the dosage of the treatment will be sufficient to overcome the evil. But we must above all hope that this new plan does not arrive too late to restore a deeply and lastingly shaken health system.