A petition signed by a thousand doctors and hospital health executives opposes the new cure of budgetary rigor imposed on hospitals in a column published by Liberation. “We are on the bone! »
The current method of financing hospitals is already sending them straight into the wall according to a petition signed by a thousand doctors and hospital health managers. A fiscal tightening can only degrade the quality of care and put the population at risk.? Since 2005, the financing of health establishments has depended on a budgetary envelope which is granted according to the number of stays recorded and the procedures performed by the doctors. This is activity-based or “T2A” pricing. This method of management corresponded to the desire to develop the “hospital-enterprise”.
The perverse effects of T2A
Public hospitals are now experiencing a contradiction desired by the various governments: they are condemned to profitability, like a private clinic, but they cannot really choose their medical activity on the basis of profitability criteria, nor their staff.
As part of this public service mission, topical pricing, the “T2A”, has generated a race for activity, leading some establishments to carry out medical acts that are not public service missions, while keeping the sick for as short a time as possible.
Some hospital directors even now go so far as to advise surgeons on the type of operations to do and not to do. As for certain specialties, considered non-profitable (diabetology, paediatrics, etc.), their budgetary and personnel resources are reduced each year.
“Always do more with always less”
With 1.6 billion euros in savings to be made in 2018, the new budgetary screw-turn proposes an envelope for hospitals which will only increase by 2%, i.e. half less than the foreseeable evolution of their expenses, recall the signatories of the forum published in Liberation by Professors André Grimaldi, Jean-Paul Vernant and Doctor Anne Gervais.
The signs of this malaise are everywhere. Several emergency services have gone on strike in French hospitals in recent weeks. Medical staff are chronically understaffed and, faced with the flu epidemic, the situation becomes untenable without additional human resources.
Everywhere, some doctors and health personnel resign, others are off work or commit suicide… as in Grenoble.
Another sign of malaise in the hospital, considering that the “situation of the public hospital (was becoming) more and more explosive”, two inter-unions of hospital practitioners (Avenir hospitalier and CPH) also called for a “Grenelle de l’ hospital “.
A Grenelle of health
Acknowledging that they have the impression of being listened to by the new Minister of Health, the signatories of the petition call for a review of the method of financing hospitals, which is based on activity-based pricing (T2A) and has, according to the comments of the Minister, “makes the public hospital believe that it should feel like a business person”. They set out their “five conditions” for “improving the relevance of care”: limitation of T2A only “to standardized and scheduled care”, “stability of tariffs corresponding to real costs”, introduction of other financing methods (planned by the government and already initiated by the previous one), maintenance in each care unit of a “rate of caregivers present” and a “relevant” grouping of activity according to the territories.
For the university hospital centres, the CHUs, the spirit of the Debré reform of 1958 must be rediscovered. If they are centers of excellence, research and training, a budget must be provided corresponding to these missions and to these only assignments. It doesn’t make sense for a cutting-edge vascular surgery department to strip varicose veins to meet the T2A!
.
