2024-04-17 11:09:04
Analysis by Philippe Leduc, doctor and health journalist, initially published on the Les Echos-Le Parisien website.
The plan will continue to crack down to reduce the growth of health insurance. Each time, it’s the same thing, taken by surprise the public authorities favor ad hoc and ultimately ineffective measures by abandoning structural reforms. It is all the more distressing as new work and opinions give substance to the real effectiveness of the basic measures. Stop the illusory plane and make way for the scalpel to cut the adhesions and rebuild, at least in three areas.
Prevention, cooperation and sharing of tasks between professionals and relevance of care are logically three of the structural actions to be carried out as a priority to both improve the health of the French and control health spending. The diagnosis is well established. Plans are initiated. An entire architecture of accountability is built step by step: in particular the strengthening of Territorial Health Councils, the establishment of prevention consultationsthe generalization of the Access to Care Service, the increase in multi-professional health homes or even negotiations between independent health professionals and Health Insurance, etc.
But this remains notoriously insufficient in terms of the tempo so the health insurance accounts are expected to be in the red for the years to come with no prospect of returning to balance in the medium term as the High Council for the Financing of Health continues to remind us. Social protection. And once once more emergency measures are being considered (reform of long-term illnesses, medical transport, franchises, etc.) without initiating fundamental reforms at the same time.
Prevention
While it is well established that actions on the healthcare system represent only a fifth of the possibilities for action in terms of prevention, public authorities are limited to consultations at key ages of life and these struggle to be implemented.
Certainly the increase in the price of tobacco and the promotion of physical exercise and sport are a good thing. But these measures do not meet the challenges. It remains to develop and amplify the measures which concern the environment, the development of public space, food, housing, mobility, work, education, social conditions and also the identification of fragilities among old people. The challenge is to reduce disabilities and dependencies, the complications of chronic illnesses and thus alleviate the healthcare system.
According to a recent study by the Astérès firm, if France were to get closer to the best ODCE countries in terms of prevention, the reduction in health spending might reach nearly 17 billion euros and the French would live two more years without illness. chronicles. However, there is no shortage of warnings. The latest, that of Antoine Flahault in his latest book “Prevenez moi!” Better health at all ages” speaks volumes.
Cooperation and task sharing
Cooperation and sharing of tasks between health professionals. She’s a bit like the Arlesian of the health system. Many attempts are nipped in the bud certainly due to corporatism but also because the public authorities put neither the will nor the means into it.
The High Authority of Health (HAS) in a recent and vigorous opinion, which went somewhat unnoticed and yet crucial, considers that “a renovated framework” is needed and that “a new milestone” must be taken. The HAS recognizes fifteen years of constant efforts but results that are too limited when it comes to combining quality, safety and satisfaction of patients and caregivers, and also better use of the sums invested. Here too you have to change the software.
HAS recommends that the administrative complexities of cooperation protocols be removed, that sufficient funding be dedicated both for the deployment and for the evaluation of these new modes of cooperation, that the teams be supported and finally that a cooperation package sufficiently rewarding for all replaces the fee-for-service payment which blocks its development. The evaluation must be conducted rigorously, if only to circumvent professional postures.
In terms of city-hospital cooperation, the Access to Care Service (SAS) is the quintessence. The SAS is in fact a new population orientation service in the health system. For the patient faced with a need for urgent or unscheduled care and when access to their attending physician is not possible, the SAS must provide access to the most “suitable” healthcare professional in town or at the hospital, with the aim also of relieving congestion in hospital emergencies. It is therefore a question of facilitating cooperation between the city and the hospital.
A mission to support the generalization of SAS has just submitted its report. It is complete and precise. In particular, he does not hide the obstacles which condition the success of the operation in the short term. Sufficient resources must be made available.
Pertinences of acts and dreams
Last example of insufficiently addressed fundamental reforms: the relevance of actions and care. Here too it is an antiphon which is based on the long term, but this period will be all the longer… as the starting line is pushed back like the horizon line. The quality of care and also the savings generated are the objective. We know that waste amounts to 20% of health spending according to the OECD, or around €50 billion in France.
The subject is complex because it calls into question the entire organization of the health system and also the practices of professionals. But the fact remains that certain measures are simple and should receive the consent of everyone, caregivers and public authorities alike.
It is surprising that certain practices persist despite all logic. For example, within the framework of conventional negotiations (currently suspended) between private doctors and Health Insurance, the Director General of the latter (Thomas Fatôme) is struggling like a “handsome devil” to encourage a reduction in the prescription of procedures. of redundant radiology, those of biology (vitamin D, TSH, blood group, ferritinemia, sedimentation rate), to limit the number of ambulance transports, to reduce polypharmacy of the elderly and the prescription of antibiotics, etc.
But is this really the place to debate these subjects? Shouldn’t professionals take the initiative and resolutely commit to this path, for example within the National Professional Councils? The same applies to activity thresholds for carrying out this or that activity. Thresholds which had to be raised and respected.
Don’t let go of the prey for the shadow
In fact, we see it today more than ever with the “emergencies” piling up on the desks of ministers in charge of health, holding both ends of the action – the short and long term – seems illusory. . It’s time to build an organization so as not to let go of the prey for the shadows.
The opinion of the Alert Committee on compliance with the national health insurance spending objective, dated April 15, strongly encourages this. He calls for “reinforced vigilance on the evolution of health insurance expenses, community care and those linked to health establishments. The “vanishing point” of the deficit of public health establishments, which is widening, is a major concern. »
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