HASuXXe century, the public hospital responded to the population’s need for care. For caregivers, it was prestigious to work there, and doctors who could not stay there consoled themselves by going to earn a lot of money in the private sector. Our health system was well ranked internationally and our public hospital was a source of national pride.
Advances in living conditions and medicine have allowed an increase in life expectancy but have also led to an increase in the expenses necessary for the functioning of our health system. The desire to limit these expenses, associated with the neoliberal wave, which has swept since the beginning of the 1980s, has led to the transformation of the public hospital into a structure for the production of care financed by activity (“charging based on activity”). activity”; T2A), which was put into competition with lucrative private structures. The objective was to improve the“efficiency” and the ” productivity “. Deficit structures would be forced to reform, improve or disappear.
In practice, loss-making structures have had no other choice than to reduce the payroll, which represents around two thirds of the hospital budget, while increasing activity: closing beds and developing outpatient services. , selection of the most profitable activities and patients, increase in the number of patients per nurse as the workload increased, salary freezes, etc. Result: more than 100,000 closed beds, and an increase in hospital activity of 19%. between 2009 and 2016, with numbers increasing by only 2%.
The failure of the hospital business
But the hospital worked more to earn less: to respect the budget voted by Parliament and the national health insurance spending objective (Ondam), the rates paid to the hospital for patient care have decreased, by around 5% between 2009 and 2016.
Therefore, despite these aggressive treatments, the hospital deficit has not decreased. In 2019, before the Covid-19 pandemic, the proportion of public hospitals in deficit was stable at 58%. Since then, the situation in public hospitals has only deteriorated, as a result of aggravating factors such as Covid-19, inflation and the drop in hospital activity due to lack of staff.
The working conditions of caregivers and the quality of patient care have deteriorated. The culture of profitability pushes hospital services to refuse elderly polypathological patients who consult the emergency room for a chronic decompensated pathology [dégradation soudaine et importante du fonctionnement d’un organe]because they are synonymous with heavy care and prolonged stays, explaining their undignified wait on stretchers.
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