2024-10-31 06:42:00
This is one of the symbols of the hospital crisis: nearly 4,900 full hospitalization beds (with overnight stay in the establishment) were eliminated in 2023, confirming a continued decline in supply, with 43 500 beds lost since the end of 2013, according to a study by the Directorate of Research, Studies, Evaluation and Statistics (Drees) published Thursday October 31.
As of December 31, 2023, the 2,962 public, private and private non-profit hospitals had exactly 369,423 full hospitalization beds, or 4,867 beds less than in 2022 (− 1.3%), according to the Drees. At the same time, 3,489 partial hospitalization places – without overnight stay – were created (+ 4.1%), to reach a total of 88,504 places. Unlike a bed, a « place » day care can generally accommodate several daily patients.
The decline in the number of beds confirms according to the Drees “a trend observed for several years”reflecting on the one hand the desire of the public authorities to “reorganize” care towards more “ambulatory”and on the other hand staff shortages, which “cannot maintain” all beds open.
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“Lack of attractiveness”
Since the end of 2013, health establishments have lost 43,500 full hospitalization beds, representing a reduction in supply of 10.5% in ten years. Some 20,900 partial hospitalization places were created at the same time (+ 31%).
The decline in full hospitalization capacity is “faster” over the last four years than before the health crisis: it decreased by around 0.9% per year on average over the period 2013-2019.
The promise of former Minister of Health Aurélien Rousseau in the fall of 2023 to “reopen several thousand beds by the end of the year”was therefore not held. If the beds close, “it’s not for budgetary reasons”but by “lack of attractiveness” care professions, he then assured.
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A decline in psychiatric beds
The decrease, however, is “less marked” in 2023 than in 2022, a year in which establishments lost more than 6,700 full hospitalization beds.
Drees further notes, in 2023, a marked decline in psychiatric beds (−2.4%), mainly in the public sector. On the other hand, home hospitalization care capacities continue to increase (+ 4.1%) to reach 24,100 patients treated simultaneously in the territory.
Widely denounced by health stakeholders, the collapse in the number of beds has been almost constant since the beginning of the 2000s, according to data available on the website of the Institute for Research and Documentation in Health Economics. The number of hospital sites also continues to decrease “under the effect of reorganizations and restructuring” (− 160 public or private establishments between 2013 and 2023, or − 5.1%), with a greater drop in the public than the private sector.
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Notice of strike
Caregivers regularly criticize these bed closures, which saturate services, put teams under pressure and increase tensions in emergency departments, causing more and more professionals to flee the hospital.
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These figures are published in the middle of a parliamentary debate on the 2025 social security budget for which the government wants to contain the deficit to 16 billion euros compared to 18 billion in 2024. The increase in health spending dedicated to the hospital sector will be limited to + 3.1%, far from the + 6% necessary, according to the French Hospital Federation (FHF, public sector).
Four unions in the health sector (CGT, FO, Sud and UNSA) have for their part filed a strike notice running from November 4 to December 21 to protest against this budget. The left, for its part, intends to have the National Assembly vote, by December, on a socialist bill – already validated by the Senate – to set a minimum number of caregivers per patient in hospital.
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**Interview with Dr. Marie Dubois, Healthcare Policy Expert**
**Interviewer:** Good morning, Dr. Dubois, and thank you for joining us today to discuss the current public hospital crisis in France.
**Dr. Dubois:** Good morning. Thank you for having me.
**Interviewer:** The recent report from the Directorate of Research, Studies, Evaluation and Statistics indicates a significant decline in full hospitalization beds, with nearly 4,900 beds eliminated in 2023 alone. What do you think are the primary factors driving this ongoing reduction?
**Dr. Dubois:** There are several interrelated factors at play. First, there has been a long-term trend towards reorganizing healthcare to favor more ambulatory care. The idea is that many treatments can be done without requiring overnight stays, which explains the increase in partial hospitalization places. However, this shift can place additional strain on full hospitalization facilities.
**Interviewer:** Speaking of strain, the report mentions staff shortages as a critical issue. How does this impact the number of available beds?
**Dr. Dubois:** Staff shortages are indeed a major concern. Many hospitals simply cannot maintain all their beds due to a lack of healthcare professionals. When there aren’t enough nurses and doctors to care for patients, hospitals have to close some beds to ensure quality care for those who are admitted.
**Interviewer:** In your opinion, why has the promise to reopen several thousand beds not been fulfilled by the government?
**Dr. Dubois:** Unfortunately, the issue is not just about funding but rather a lack of attractiveness for care professions. Many potential healthcare workers are deterred by the working conditions and stress associated with the current healthcare environment. If we don’t address these underlying issues, we can’t expect to see a reversal in trends.
**Interviewer:** The report also highlights a significant decline in psychiatric beds. What does this mean for mental health care in France?
**Dr. Dubois:** The reduction in psychiatric beds is alarming. It signals that we are not adequately addressing the mental health crisis. As psychiatric facilities shrink, there are fewer options for individuals in need of intensive support. This could lead to increased pressure on emergency services and less effective treatment for those who need it most.
**Interviewer:** With the trends you’ve mentioned, what do you think needs to change moving forward?
**Dr. Dubois:** There needs to be a comprehensive strategy that not only focuses on increasing the number of beds but also addresses staffing shortages, working conditions, and support for healthcare workers. We also need to rethink how we allocate resources to ensure that both general and mental health care are prioritized effectively.
**Interviewer:** Thank you, Dr. Dubois, for your insights on this pressing issue. It’s clear that the public hospital crisis in France requires urgent attention from both policymakers and society as a whole.
**Dr. Dubois:** Thank you. It’s crucial that we continue to advocate for necessary reforms in our healthcare system.
