Tribune. For nearly twenty years and the 2007 Hospital plan, launched in 2003, France has been engaged in major programs to renovate its hospital stock, considered to be dilapidated, in particular for university hospital centers (CHU).
Until then, two main principles had guided the management of these projects, characterized by a strong centralization: on the one hand control of operating expenses; on the other hand, the construction of modern technical platforms, guided by the prevalence of technical standards and the search for economic performance, since it was a question of developing activities valued by pricing per activity (surgery, radiology, oncology , cardiology, etc.).
A formidable centralized device
Like the health system as a whole, the public policy of hospital investment was also characterized by forgetting the infectious fact and its architectural consequences. Let us remember the suburban hospitals created after the Spanish flu and reused at the start of the AIDS epidemic, or even the sanatoriums reserved for tuberculosis …
The pandemic and the health investment program announced by Prime Minister Jean Castex on March 9, following the conclusions of the Ségur de la santé, shake up these various principles.
The first sign of this change was the announcement, on July 21, 2020, by the Minister of Health Olivier Véran, of the end of the interministerial committee for the performance and modernization of the hospital care offer (Copermo). Created in 2013, the Copermo had proven to be a formidable centralized hospital restructuring system. One-stop shop for any health establishment that had real estate modernization projects exceeding 50 million euros, it made investment aid conditional on the achievement of performance indicators by hospitals.
This resulted in constraints on the wage bill, hospitalization capacities and the use of square meters (at the expense of storage spaces, available offices, etc.). Despite the formal participation of the medical commissions of establishments, the process was de facto piloted. by the school directors, who negotiated – sometimes for several years – the outline of the projects with this committee, in which the general directorate of public finances (DGFiP) actually played the leading role.
Inadequate supply
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