2023-07-26 17:14:03
The latest figures from health establishments in 2021 show a rebound in hospital activity, an increase in the number of employees in public hospitals which continues and alternatives to conventional hospitalization which regain their dynamism in 2021. This DREES file explores the main categories of health establishments, hospital reception capacities, activity in full or partial hospitalization, the number and salaries of hospital staff. Focuses on establishments in the DROMs and on the economic and financial situation of public hospitals and private clinics complete this work.
The latest figures from health establishments in 2021 show a rebound in hospital activity, an increase in the number of employees in public hospitals which continues and alternatives to conventional hospitalization which regain their dynamism in 2021.
In 2021, 12.7 million patients were hospitalized one or more times in one of the 2,987 public or private health establishments in France. At the end of 2021, the capacity of these establishments is 383,000 full hospital beds and 82,000 partial hospitalization places.
A less marked decline in the number of beds in 2021 than in 2020
Over the past twenty years, the organization of the care offer has evolved towards a significant increase in the number of places for partial hospitalization (without overnight stay) and hospitalization at home, in view of a continuous reduction in the capacity of full hospitalization (beds). Innovations in medical technologies and drug treatments have made this “outpatient shift” possible.
Between the end of 2020 and the end of 2021, the number of full hospital beds able to accommodate patients fell by 1.0%, a rate that is close to the trend observed during the 2013-2019 period.
An increase in full hospitalization activity in 2021
With the health crisis, the number of full hospitalization stays in France has experienced an unprecedented drop (-12.4%). In 2021, this number of stays started to rise once more: healthcare establishments paid for 10.6 million full hospitalization stays, an increase of 3.3% compared to 2020. In particular, the number of full hospital stays increased by 3.7% in short stays (-12.0% in 2020) and by 4.3% in psychiatry (-14.4% in 2020).
The hospital sector also recorded 16.9 million days of partial hospitalization (without overnight stay) in 2021, an increase of 26.3% which offsets a significant part of the 23.5% drop observed in 2020.
Alternatives to conventional hospitalization regain momentum in 2021
In addition to these treatments, there were 14.9 million chemotherapy, radiotherapy and dialysis sessions, up 4.5% compared to 2020. This rebound does not completely erase the effects of the marked slowdown observed in 2020, characterized then by the stagnation in the number of chemotherapy sessions and the 4.1% drop in the number of radiotherapy sessions.
Moreover, home hospitalization (HAD) continues to grow in 2021, but at a slower pace, followingmath of the strong acceleration observed in 2020. The number of stays increased by 3.7% (+15.8% in 2020) and the number of days by 2.5% (+10.5% in 2020). Two reasons can explain this acceleration of HAH activity during the health crisis: the HAH treatment of new patients with Covid-19, but also the postponement of part of the non-Covid-19 activity of MCO to HAD. Due to the risk of contagion in health establishments and deprogramming, in particular to assign staff to Covid-19 units, many patients were cared for at home rather than in conventional hospitalization.
373,000 Covid patients hospitalized in 2021, i.e. 70,000 more than in 2020
In 2021, 373,000 patients were hospitalized at least once with a primary or associated diagnosis of Covid-19, i.e. 70,000 more than in 2020. The average length of stay remains higher for Covid-19 stays than for other pathologies. The average length of stays with a main or associated diagnosis of Covid-19 in full hospitalization thus ranges from 11.3 days in MCO to 37.3 days in SSR in 2021. In comparison, the average lengths of stays (all reasons combined) in full hospitalization are 5.6 days in MCO and 33.0 days in SSR. These differences can be explained by the greater complexity of the stays of patients with Covid-19, with in particular a significant proportion of critical care treatment. Due to this longer average length of stay, in 2021 Covid-19 represents a larger share of full hospital days (6.3%) than stays (4.0%). The median length of stay for patients with Covid-19 has however been reduced over the waves, due in particular to the rejuvenation of the hospitalized population and vaccination.
In 2021, the increase in salaried staff in public hospitals continues, at a more modest pace
Between the end of 2020 and the end of 2021, the salaried workforce in the public hospital sector increased by 0.6%, to reach nearly 1.1 million employees at the end of 2021. This increase follows a 1.9% increase in the workforce between 2019 and 2020, made necessary by the health crisis.
Among the employees of public hospitals, the increase in medical staff remains faster than that of other nursing staff. The salaried workforce of public medical personnel increased by 1.9% between the end of 2020 and the end of 2021 (+2,700 employees), a rate that remains well above the trend observed before the health crisis, from the end of 2013 to the end of 2019 (+1.3% per year on average).
The number of nurses increased by 24% between the end of 2003 and the end of 2020, an increase close to that of the number of doctors and similar. Their share of the salaried workforce also increased, rising from 24.1% to 25.9% over the same period. The share in the hospital salaried workforce of nursing auxiliaries (20.9% at the end of 2020) and administrative staff (10.8% at the end of 2020) has remained broadly stable for seventeen years.
On the other hand, the number of non-medical nursing staff in the public sector fell slightly in 2021 (-0.3%, i.e. -1,800 employees). Finally, the salaried workforce of non-medical staff in the public sector will accelerate and increase by 2.0% in 2021 (+5,400 employees).
Despite the persistence of deficits, the debt reduction of public hospitals is accentuated in favor of the Ségur de la santé
In 2021, the deficit in the financial accounts of public hospitals widens once more, following the apparent improvement in 2020, driven by the exceptional support measures in the face of the health crisis. Their net result amounted to 415 million euros, or -0.4% of revenue (-0.1% in 2020). The increase in expenditure (+6.8%) is more pronounced than that of revenue (+6.4%), which explains the widening of the deficit. The investment effort will pick up slightly in 2021, due in particular to the commitments decided during the Ségur de la santé.
The deleveraging of public hospitals continues : the financial independence ratio, which measures the share of debt in permanent capital, has fallen for the third consecutive year. It goes from 51.1% in 2020 to 46.8% in 2021. The share of over-indebted institutions also decreases markedly and reaches 26.1% in 2021 (31.4% in 2020). These more marked improvements in 2021 are due to the measures to restore financial capacity planned under the Ségur de la santé.
Healthcare establishments in 2021, Under the direction of Fabien Toutlemonde – Contributors: Bénédicte Boisguérin, Noémie Courtejoie, Simon Delage, ChristopheDixte, Yves Dubois, Laura Gaimard, Nathalie Guillon, Khadija Jabri, ÉdouardMaugendre, Diane Naouri, Benoît Ourliac, Jehanne Richet, Charline Sterchele, FabienToutlemonde, Annick Vilain, Albert Vuagnat, Les dossiers de la Drees, n° 111 – July 2023
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