Three hundred hospital doctors have signed a petition in the daily Release denouncing the plan for transformation, My health 2024. The collective recognizes the accuracy of the diagnosis pointing to the overload of the hospital emergency departments, the inadequacy of the health care system the explosion of chronic diseases and failure of their prevention, as well as the non-resorption of the medical deserts. But practitioners are concerned about some provisions which show how much some are stuck in their habits of a world disappearing. They complain in particular of the closure of beds, which, however, is an absolute necessity, which is not to say close institutions, that it will be necessary to convert to tasks near which we are sorely lacking. In fact, the too-full-stay hospital classic mobilises people whose work could be done otherwise or elsewhere. All of the hospitals are not full to the brim and overwhelmed by demand, emergencies included ! Just do a tour of France to see it, but it is the cache !

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The flare-accelerated technologies related to digital tools and robotics transformed our ways of acting and impacts the number of staff members dedicated to specific tasks. The backwardness of France in the development of medicine ambulatory is explained in large part by the refusal of some fellow hospitallers to adapt their practices to these new modes of operation. Our country is in 12th place in Europe for the surgery of tonsils as an outpatient (23 %), compared to 86 % in Finland and 73 % for Sweden. Want to maintain beds, to what to do ? Keep patients warm in order to make people believe that there is a lot of work ? Or perhaps increase the rate of nosocomial infections ?

support co-ordinated

France, write the authors of the petition, would not be in the 3rd place of the OECD countries in terms of health expenditure, but to the 14th place (with 4 600 dollars per capita per year, according to them), after Canada, Belgium, Austria, the netherlands, Denmark, Germany and Sweden (5 to 500 dollars), Switzerland (8 000) and the United States (10 000). But where had they fished this data totally wacky ? France is nearly tied with Germany, which stands at the third place of the ranking behind the United States and Switzerland. The per capita health expenditure of the Hexagon were 2 977 € 2107 (11.5% of the GDP), 3 363 us dollars and not 4 600 as claimed by the authors of the tribune. The remaining burden for households is the lowest in Europe (8.5 per cent), or 252 euros per year. As to salaries of health professionals, the raw numbers mean nothing if they are not compared with the cost of living. I acknowledge that our nurses and our physical therapists employed in public are poorly paid, and this, more especially that their studies are much more expensive than those of the carabins, but, to swim in the curse and in the vagueness, it sows doubt in order to scare them. There are 500,000 nurses in public hospitals in France, as is stated, a peremptory nature, the signatories, but 323 000. The private educational institutions, hospital or not, the long-term care facilities, health centers, the maternal and child protection, as well as other governmental institutions, also employ nursing employees, and 110,000 have an exercise liberal.

My colleagues are afraid to see the medicine of the city through the gap in dépeçant the hospital system public. They worry about having to exercise in houses and health centres, arguing that their time is counted. But do they understand that the fluidity of the relationships between physicians and hospital is the future that call for the sick in a support truly coordinated ? The petitioners will prevail against the industry, easy prey, and its profits, ” wonderful “, not including anything that represents the development of a molecule. When we will no longer have the major pharmaceutical groups, the same will cry in the skirts of the authorities by accusing them of having given away our jewels, and not to have fast access to innovative products.

cling to the traditional solutions

The class also complains about the state of psychiatry… But who is responsible, if not well, often the actors themselves, who have rarely been able to hear and play collectively ? In the next 20 years, psychiatry will be dismembered by the analysis of artificial intelligence, of which the diagnostic accuracy is increasing every day. Again, clinging to traditional solutions without a glimpse of what a real tsunami is doomed to failure.

The pricing activity (T2A) will be revised and reduced to only a part of the financing of care facilities. It will be correlated to the relevance and the quality of the result of the acts performed. This new way of paying players is virtuous in that it will provide the income necessary for those who will have acted in compliance with the new rules. Why the disparage ? The package for an episode or pathway of care is the right way to pay the professionals and their structures, including surgery, such as in the management of chronic conditions. Stay in the meadow until everything collapses is it tenable ? In any case, this is not responsible.

The “reporting” designed to assess the medical acts, contrary to the statements of the signatories, will not require almost any additional effort. The data is there, it just need to mill it in real time in order to place each player in a cloud of points which will define the averages and standard deviations. Good algorithms will do the job better than a social security inspector. My colleagues know that the artificial intelligence is already present to ensure this eve as it does in other areas. Hospitals that have implemented this evaluation in real time, such as in Glasgow or Hamburg, have teams among the best in the world in their specific field of intervention. The accreditation will no longer require review every four or five years, but will be day-to-day. Such a policy will leave more room for the poor and the deviant, we understand that this may hinder some. As to the risk that this assessment of the quality leads in the long-term insurers to play the bonus-malus applicable to patients, the signatories point to a hypothetical risk to better evade themselves in control of their own practice. They are speaking out, pointing out that nothing is intended to reduce the prescriptions and wrongful actions, while the assessment of the relevance and results of medical procedures is one of the priorities of the plan My health 2024.

Old language

The pseudo-risk clinics, homes and health centres through the gap of a partnership which would decrease the weight of the hospital should be commended instead of being vilified, with tremolos in the voice. Each act in accordance with his competences in the structures best suited. All the rest is not that old furrows of professionals who still think in the Twentieth century. To say that we are witnessing the end to the great fire sale of the public hospital service is a lie.

to Reduce the health policy to the analysis of the number of passages per year to the emergency room, the time to find a bed available in a service corresponding to the needs of patients admitted to the hospital in an emergency, the rate of absenteeism of nursing staff, and patient satisfaction, is insufficient in that these items are first the proof by a + b a disorganization of the teams, including physicians, are often themselves responsible. Too easy to see on the neighbors of its own shortcomings. Let’s at least lucid. Gold put in place other forms of cooperation and internal organization doesn’t have to cost billions of euros, but the good sense of listening and an ability to change its habits.

The 300 signatories of the 45 000 hospital doctors, or just 0.75 per cent, have they actually read the entirety of the project document 2024 before they appear in the list of the protesters ? The plan launched by the president of the Republic and implemented by the Prime minister and the minister of Solidarity and Health, has the goal of rebuilding social protection to adapt it to the Twenty-first century. He challenges the traditions and disturbs the small chapels. So much the better, it is a good sign ! At least, we will know who is who and who wants what ! This plan has the ambition to open up the health world in general and the medical world in particular, so that all health professionals, public and private together, to make war on the disease and not between them. I want it to succeed by counting on the new generations, whose collaborative spirit said will be very useful to achieve this deep transformation and essential to our health-care system. To them the future, the other the regrets of an old world that erases the benefit of a better support of the suffering.

* Guy Vallancien is a member of the Academy of medicine and president of CHAM (Convention on Health Analysis and Management, who reflects on the transformation of health systems in europe.

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