Too long waiting times, too short consultations, for the French, the quality of care in hospitals is deteriorating. Ditto for some doctors who denounce “hospital-business”.
A majority of French people (60%) believe that reception conditions at the hospital have deteriorated in recent years, according to the Observatory of access to care Jalma / IFOP 2014 published on Monday. To justify their mistrust, patients point to the excessively long waiting times for obtaining a medical appointment. 42 days on average before a surgical operation and 49 to get an appointment with a specialist. Worse still, some patients find the consultations too short. “With the feeling of being sent by their doctor,” says Mathias Matallah, president of the Jalma consulting firm.
16 min for a profitable consultation
The French have a “correct impression” of reality, confirms Professor André Grimaldi, diabetologist at Pitié-Salpêtrière (Paris). And this observation was “predictable”, insists this specialist. “We started by installing stopwatches in consultation rooms in certain hospitals. All this at first, only, to learn and understand why some doctors are longer than others. “Result,” we transformed the hospital into a business. “We ask hospital practitioners to perform more and more medical procedures, favoring more and more profitable procedures,” he adds.
Some hospital services go even further. According to their calculation, a consultation for a chronic disease (diabetes, AIDS …) is only profitable if it does not last more than 16 minutes.
For Professor Grimaldi, the main enemy remains the activity-based pricing (T2A) which is based on a logic of measuring the nature and volume of activities. “The T2A dictatorship is identical to that of an industrial chain. She pushes the doctor to make numbers, and 20 and 30 and 40 patients. Doctors saturate them, they have the feeling of deskilling their profession. “
Listen to Prof. André Grimaldi, diabetologist at the Pitié Salpêtrière hospital: “ The beds must be full. It has to run constantly. Hospital directors have been saying for 10 years: “we must increase activity”. “
The most attractive clinics for doctors
Another explanation to justify these excessively long waiting times, that provided by Mathias Matallah, from Jalma. According to him, since the introduction of 35 hours in the hospital, doctors work less. “This causes shortages of physician staff in certain departments at several times of the week. “
In addition, this health economist recalls that hospital careers are less and less attractive. In figures, the vacancy rate for full-time positions at the hospital is around 23%, and 40% for part-time positions.
Listen to Mathias Matallah, president of the Jalma cabinet: ” Doctors work less in the hospital. More and more of them have special exercises. “
Medical care not covered by the Social Security
In addition, the French also complain about the financial cost of a hospital stay. This is the case, for example, for single rooms which are chargeable in French hospitals (45 euros at AP-HP), as well as in clinics. Consequently, if the patient does not have a mutual, this sum will not be reimbursed.
In the Jalma study, the cost of care is the second most common cause of foregone care.
The hospital victim of red tape
Faced with this worrying observation for patients, certain major players in the hospital find mitigating circumstances for the managers of these establishments. Frédéric Valletoux, president of the Hospital Federation of France (FHF), denounces in this regard “the administrative overload to which the staff and directors of hospitals are victims. “
For him, the simplification shock desired by François Hollande, which concerns companies, individuals and administration, must also see the light of day at the hospital.
Listen to Frédéric Valletoux, president of the FHF: ” In hospitals, there is a lot of bureaucracy, red tape, and over-administration. “
Wifi in Ile-de-France hospitals in 2015
So, in an attempt to improve reception conditions, officials are starting to take initiatives. Among them, the director general of the AP-HP, Martin Hirsch. “At the end of spring 2015,” he announced, “we will be implementing online payment for patients – rather than these countless reminder letters – and will open the new website, which is more informative for patients. Finally, we can announce that in 2015, low speed WiFi will be deployed throughout the AP-HP and will be free for everyone, patients and staff. ”
Ile-de-France patients who wait hours in hospital waiting rooms (especially in emergencies) will at least have the privilege of being able to surf the Internet …
.
