Lhe hospital structures are moving away from rural areas. Hospitals are coming together in networks and are in the process of changing our hospital landscape, modifying our access to care and territorialising the offer. How do these networks of territorial hospital groups (GHT) meet the care needs of the population, of the quality expected in the emergency department?
Since 2016, public sector establishments have been required to group together. Within these networks, the structures must cooperate and coordinate around patient care and support. The patient is no longer cared for by an establishment, but by one of the 135 networks of establishments dividing the French territory. The aim is to open up the patient thanks to a local offer. Whatever the point of entry into the GHT, the patient is referred to the most suitable establishment for his treatment. This can also lead to a decrease in waiting times. Patients are oriented, thus limiting inadequacies in care.
At the same time, the concentration of technical platforms and high-tech equipment in a limited number of establishments enables quality to be improved through learning-by-doing. Innovation then becomes accessible to all according to needs.
The convergence of information systems and their sharing is a definite advantage of GHTs. Managing care involves being able to transmit all the information necessary to each of the players concerned in real time. One could even envisage this convergence of information systems extending to all healthcare professionals, and therefore to community medicine. The inclusion of digital health would be facilitated. A high-performance information system would partially respond to the aging of medical demography and medical deserts.
This centralization nevertheless supposes counterparts. The networking of establishments makes decision-making more difficult, in particular logistics such as the purchase of materials. The positioning of the poles, if this is well thought out, can alleviate these operating difficulties.
The need for consensus
This virtuous system involves a number of prerequisites. The first is to rethink the allocation of hospital budgets. The current financing (T2A) is done by hospital establishment, which has the consequence of putting them in competition with each other for the care of the patient: a contradictory system with the stated desire to have the establishments cooperate with each other. Moreover, the latter may be encouraged to keep the patient unnecessarily long in their service to optimize their budget. Thus, the patient journey would not be not necessarily coordinated by the needs of care of the latter, but in order to maximize the budget of each of the GHT structures. This behavior would lead to an artificial multiplication of stays for budget optimization purposes. It is not the T2A which is pointed here, but its mode of attribution.
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