Lhe crisis in local medicine would be due to a drop in medical demography through the effect of a numerus clausus extended beyond reason. True, but only partially. The number of general practitioners has fallen significantly, of course. But situations of abandonment will mainly appear in areas where the density has already been very low for many years. Back to basics.
We are in the 1970s, at the time of the first oil shock. Inflation is soaring and, beyond that, health spending. Our health system, which is, then, above all a care system, is then co-managed by Medicare and the unions of liberal doctors.
The State, absorbed by other concerns generated by a tense international situation and the first oil shock, therefore left these two “partners” to settle the problem and endorsed their proposals. The National Health Insurance Fund and the unions of liberal doctors, anxious to preserve, one its quasi sovereign power, the others their rents of situation, imagine a system regulating the supply of care without touching the foundation of a device imagined at the end of the war.
Band-Aid Policy
The number of students leaving first year will therefore be drastically limited, and the lucky winners will be able to consider a medical career like their elders.
This situation will continue until the middle of the 2000s without giving, moreover, the expected results. Reducing the number of health professionals does nothing to solve the growth in health expenditure, considered beneficial by some, unbearable by others.
Paralyzed by the power, supposed or real, of the liberal medical world and by a growing public hospital service, successive governments gave up trying to reform the system in depth, contenting themselves with a policy of tinkering (public-private collaboration, incentives financial costs for the establishment of professionals, financial participation of patients, regionalisation, generalization of excess fees, etc.). These measures will not prevent the emergence of crises, the acme of which seems to be unfolding today.
They will even precipitate the crisis of the public sector, because the liberal sector does not have any more to ensure the permanence of the care. The government has also authorized fee overruns, without setting a limit, which adds to the loss of attractiveness of the public sector.
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