Nicolas Da Silva is an economist and lecturer in economics at Sorbonne-Paris-Nord University. He calls on the State to show imagination to improve the organization of healthcare provision throughout the territory.
Is the financial offensive in the health sector partly the result of state failures?
Finance benefits from the absence of an organized public response to the problems facing the private medicine sector. And she proposes to compensate for these failures, in fact. When you have unmet health needs, with an insufficient number of doctors, medical deserts and saturated emergencies for lack of alternative, it should not be surprising that financial groups take the initiative and find their place in the care pathway, by reorganizing the offer and investing massively. And this in all fields: biology, radiology, but also primary care.
Legally, public authorities have even facilitated private initiatives and the entry of investors into the capital of medical structures. Moreover, we hear more from those who complain, but some doctors are there and do not complain: when a private group takes care of all the administrative tasks and tells you to concentrate on your core business, that responds also to an expectation formulated by professionals which is not sufficiently heard.
You warn of the dangers of this trend…
The financiers seek to remunerate their capital and they are in their role. But the risks are multiple. Firstly, the risks of inequality, because they will only invest where it is profitable, which can lead them to abandon actions, geographical areas, pathologies and populations that are less interesting from a lucrative point of view. . In the field of health, the remuneration for the provision of care comes from public funding, which is not extensible, so how can we make a profit without it being on the backs of patients and health professionals?
I add the risk of dispossessing these same professionals of their work tools, which doctors are becoming aware of. If they no longer have control of their tool, they may lose their freedom of exercise, and financial logic could take precedence over medical choice and the interests of the patient.
How can we limit these risks?
Already, it would be beneficial to seek to quantify and qualify the trend observed for several years. We lack data, it is a mammoth task to construct a map of financiers and financing. Then, it is necessary to regulate the legal statuses of the groups formed to ensure the real independence of the practitioners. Finally, public authorities must react and have a little imagination to better organize the offer in the territory: invest massively in certain under-resourced regions, better remunerate certain installation procedures, think of a lasting organization which cannot not just be liberal…
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