A petition signed by a thousand doctors and hospital health executives opposes the new course of budget discipline imposed on hospitals in a forum published by Libération. "We are at the bone! "
The current mode of financing of the hospitals sends them already straight in the wall according to a petition signed by a thousand doctors and cadres of hospital health. A budgetary trick, can only degrade the quality of care and put the population at risk. Since 2005, the funding of health facilities depends on a budget allocation that is granted according to the number of registered stays and acts performed by doctors. This is activity-based pricing or "T2A". This management method corresponded to the desire to develop "hospital-business".
The perverse effects of T2A
Public hospitals today experience a contradiction desired by the different governments: they are condemned to profitability, like a private clinic, but they can not really choose their medical activity on criteria of profitability, nor their staff.
As part of this public service mission, the current rate, the "T2A" has generated a race to the activity, leading some institutions to perform medical acts that are not public service missions, while keeping the patients as short as possible.
Some hospital managers even go so far as to advise surgeons on the type of do's and don'ts. As for certain specialties, considered as unprofitable (diabetology, pediatrics ...), their budget and staff resources are reduced each year.
"Do more with always less"
With € 1.6 billion in savings to be achieved in 2018, the new budget round proposes an envelope for hospitals that will only increase by 2%, or half of the foreseeable evolution of their expenses, recall the signatories of the tribune published in Libération by Professors André Grimaldi, Jean-Paul Vernant and Dr. Anne Gervais.
The signs of this discomfort are everywhere. Several emergency services have gone on strike in French hospitals in recent weeks. Nursing staff are chronically understaffed and, faced with the epidemic of influenza, the situation becomes untenable without additional human resources.
Everywhere, some doctors and health workers resign, others are off work or commit suicide ... as in Grenoble.
Another sign of unease at the hospital, saying that "the situation of the public hospital (became) more and more explosive", two inter-unions of hospital practitioners (Avenir hospitalier and CPH) have also called for a "Grenelle de l ' hospital ".
A Grenelle of health
Recognizing that they have the impression of being listened to by the new Minister of Health, the petitioners call for a review of the mode of financing hospitals, which is based on activity-based pricing (T2A) and, according to from the minister, "makes the public hospital believe that it must feel like a company spirit". They expose their "five conditions" to "improving the relevance of care": limitation of T2A only "standardized and programmed care", "rate stability corresponding to real costs", introduction of other modes of financing (planned by the government and already committed by the previous one), maintenance in each care unit of a "rate of caregivers present" and a "relevant" grouping of the activity according to the territories.
For University Hospital Centers, CHUs, we must find the spirit of the Debré Reform of 1958. If they are centers of excellence, research and training, we must provide a budget corresponding to these missions and these alone missions. It does not make sense to have advanced vascular surgery services stripping varicose veins to satisfy T2A!