Investments from Ségur de la santé will not really change the way hospitals operate, says Olivier Milleron, cardiologist and member of the Inter-Hospitals collective.
“We have the impression that it is sprinkling, an emergency plan, but that once again the hospitals will fall back into a functioning which is deleterious”, reacted Tuesday March 9 on franceinfo Professor Olivier Milleron, cardiologist at the Bichat-Claude Bernard hospital in Paris and member of the Inter-Hospitals collective, while Prime Minister Jean Castex presented the investment component resulting from the debates of Ségur de health, on the sidelines of a trip to the Nièvre. A global envelope of 19 billion euros over ten years will thus be injected into the health system. For Olivier Milleron, the plan compensates for “Investments that did not take place”, but on the merits, “The governance of hospitals has not changed”.
franceinfo: The plan announced by the Prime Minister is a breath of fresh air or a catch-up in relation to investments that have not taken place for years?
These are investments that have not taken place because the hospital problem has been a funding problem for years. If you have a household that is over-indebted because it has too low a salary and too much rent, you can take back a third of its debt. But if you don’t increase his salary or if you don’t decrease his rent, he will continue to take on debt. So this is exactly the same for the hospital. The problem with the hospital is that the budget is too low. Once again this year, the Social Security financing law is asking hospitals for one billion in savings in 2021. And activity-based pricing reinforces this phenomenon. It was a promise from candidate Macron to remove activity-based pricing. And we do not see anything coming, neither on the replacement of the financing of the hospital by something other than the pricing to the activity, nor by the financing of the hospitals according to the needs and not according to financial criteria fixed by Bercy. So we don’t really see how this stroke of a third of the debt will change things.
Do you think that we are fabricating situations of financial difficulty for the next few years?
Yes. After a year of Covid in hospitals, we are told that activity has dropped because we have had Covid and that we are in deficit and that we have to go back to the world before. That is to say, choose lucrative activities with less staff because it is expensive. We continue to carry out hospital restructuring programs where beds are closed. In Bichat-Beaujon, where two large public assistance hospitals will be merged, there are still plans to remove 300 beds. So, I hope that the billions distributed will allow Martin Hirsch to announce that finally, we are no longer removing 300 beds and that we will be able to finance at least the maintenance of the health care offer. But in the field, we are not at all claiming victory. As a reminder, the hospital staff mobilized well before the Covid. We demanded that the salary of hospital workers join the OECD average. There was an increase of 183 euros, but we are still far from the OECD average. And compared to the private hospital, the public hospital is not competitive in attracting the best. The way hospitals are funded has not changed. It is a mode of financing which leads to the deficit of more than half of the hospitals. And the governance of hospitals has not changed. It is always the director who remains the sole master on board and his supervisors above all set him financial objectives.
Investments for hospital expansions or renovation of emergency services or nursing homes remain essential?
They are essential. But what is annoying is that in normal operation, hospitals must be able to finance this kind of maintenance. What they are doing is a back-up plan, because the hospital has been underfunded for years. And there, we put two billion on the table. We can compare them. Over 10 years, it is 15 billion euros for aeronautics, 8 billion for the automobile. So yeah, that’s a lot of billions. But for the hospital to truly become the government’s priority objective, we are still far from it.
Would these investments have taken place without the health crisis?
I think that with the crisis, people saw that the hospital workers, in the end, were not bad spenders who did anything. When we asked them to organize, they knew how to do it. So maybe the balance of power has changed a bit compared to the old world where we were told that, anyway, we no longer had the means to finance the public hospital. So I think the government realizes that the population is keen on the public hospital, that it is one of the only institutions that has a consensus in this country and that it is very difficult for them to let it down. But here, we are still worried because basically there aren’t many changes. There are announcements, billions that are going to be distributed, but we have the impression that it is sprinkling, an emergency plan, but that once again the hospitals will fall back into an operation which is deleterious for them.