The French Minister of Health, Olivier Veran, confirmed in the Castex government, has listed 33 measures for the health system in France. In-depth analysis by Enrico Martial We
are proceeding through announcements and programs, but in the meantime, on Tuesday 21 July the French health minister, Olivier Veran, confirmed in the government of Jean Castex, listed 33 measures for the French health system.
The concertation method – which constitutes the figure of the new government but which is already active for individual problems since the beginning of 2019 – has entered the health issue with a negotiation, with discrete tensions and some demonstrations, from 25 May to 10 July, which it involved around 300 people representing 90 trade union and independent organizations, doctors and health personnel. The work was coordinated by Nicole Notat, secretary general of the CFDT, a trade union of the socialist area (and of the Catholic left) between 1992 and 2002, but who supported Alain Juppe’s pension reform in 1995. The consultation, which was given the name of “Segur de la sante”, from the avenue where the ministry is located in Paris, also took place with an online consultation (almost 120,000 participants, with open and outline questions) and 200 territorial meetings. The conclusions have a financial and an organizational side and were supplemented by the proposals of Minister Veran. Although the health system is different from the Italian one (which is universal compared to the French health system), the list of issues reminds us of our debate.
From a financial point of view, 8.2 billion euros were allocated for hospital staff, at various levels, (it has been said for nurses about 180 net per month) to which must be added 19 billion, 13 of which destined in part to absorb the debts of hospitals, including those of the Covid crisis, and 6 billion for the structures. Of the latter, 2.1 billion are needed to renew a quarter of the places in the EHPAD, the social assistance centers for the elderly that correspond to our RSAs, 2.5 billion for urgent interventions on hospitals and 1.4 billion for digitization, also pushing on telemedicine, according to the experiences gained during the crisis.
In terms of territorial participation – in line with the Castex government – the planning of spending under 100 million euros is decentralized to “regional conferences for health investments”, while for the upper level it remains at a National Investment Council which from 2021 will replace the current criticized vertical and inter-ministerial structure (Copermo), synonymous with reduction of beds and closures. Local subjects and elected representatives will participate in both instances.
The same hospitals, accused of bureaucratic excesses, will have a more participatory governance, correcting the 2010 law with the contributions of doctors, health personnel and patients. Regional Health Agencies (ARS, a decentralized form of the state) will strengthen their departmental (provincial) level again with the involvement of local elected officials. As regards the upcoming decisions on overall health expenditure, after the preparatory studies, a new consultation session in 2021 must be envisaged, also with more shared modalities, and therefore more local responsibilities. In other words, local and regional political participation in decisions will be accompanied, in a progressive way, by local co-financing of the health system.
Already during the Covid-19 emergency, about 9,000 additional beds have been created, and the reopening of structures or the expansion of reception has been discussed, in response to past cuts. With the financial allocations announced, in addition to general investments, 4000 new beds are also planned “on demand”, that is, according to seasonal peaks or epidemic ones (with a mechanism yet to be specified), 15,000 new hires and 2000 training places for paramedics, with 250 new teachers at the University, to double the number of social and health personnel by 2025.
