Does the Minister of Health have to be a doctor?

The suggestion comes up regularly: place a professional at the head of the department representing him. Substitute the political elite cut off from realities with field workers, those who know better than anyone what shapes their daily lives.

This Thursday, on the set of Political Broadcasting, it was Emmanuel Macron who brandished the idea. “I wish to appoint a doctor for Health”, explained the candidate for the presidential election on France 2. If the proposal seems attractive, pragmatic, it does not guarantee any political effectiveness: a doctor does not necessarily have the best diagnosis for himself… Claude Lepen, health economist, gives his point of view.

Is it preferable, or even necessary, for a Minister of Health to be trained as a doctor?

Claude Lepen: In fact, it can be complicated because the prerogatives of the Ministry of Health have evolved a lot. Before the years 1990-200, there was a Minister of Social Affairs who managed the accounts of Social Security, and a Minister of Health who dealt with questions of public health, vaccination, prevention, health security … and who lacked budgetary and financial skills. There were thus historical couples – Michel Barsac and Philippe Seguin, who marked the spirits.

Then, things changed, Health took over from the Ministry of Social Affairs: the couple merged. Today, the competences of the Minister of Health are at the same time medical competences of public health, and financial competences, knowledge on the social protection of the French.

These are not the same attributes: it is better to be a doctor for the public health part, or at least to have a medical, epidemiological culture … But to manage the accounts of Social Security, it is better to have a financial, economic perspective. , access to healthcare, social protection. A doctor can be a good Minister of Social Security but he has no specific legitimacy, and vice versa. So, in this configuration, the responsibility of the ministry does not have to lie with a doctor.

Listen to the full interview with Claude Le Pen:

Out of corporatism, wouldn’t a professional risk being the minister for physicians before being the minister for patients?

Claude Lepen: This is one of the questions we can ask ourselves. Is the Ministry of Education the Ministry of Teachers? Is the Ministry of Defense that of the Military? There is always a double belonging; we defend a sector but also the workers of that sector.

Indeed, in Health as elsewhere, there is a risk that the Minister will defend the corporate interests of a profession. Afterwards, it is a question of ethics, of political choice, of the ability to make major national choices, and to detach oneself from the corporate interests of professionals.

In the end, isn’t it better that doctors occupy positions within the ministerial cabinet rather than at the head?

Claude Lepen: Of course, a doctor can be a minister: he is not prohibited from having financial skills, some practitioners have even been budget ministers, such as Jérôme Cahuzac.

But I do believe that the right configuration, in the current state of things, is rather to have a Minister of Social Security who deals with financial and social issues, and a strong cabinet with health representatives. public – not necessarily clinicians, but rather specialists in collective health, social medicine.