Christian Estrosi , President of the Nice Côte d'Azur Metropolis and Mayor (LR) of Nice
At a time when we have just experienced the greatest pandemic in our contemporary history, our health system is at the heart of all attention. It was time!
Improving working conditions, in particular the salary of our caregivers is naturally essential. But it should not exempt us from questioning the organization of health in France. Despite the exceptional dedication of its players, the French health system has revealed an operation whose bureaucratic rigidities have deeply affected its effectiveness. How can we explain, when transfers of resuscitation patients from one region of France to another were organized, that resuscitation beds in private or association structures remained empty? How to explain that liberal medicine was not at all associated with the management of this crisis? How to understand that the mayors of France who are, by their mandate, chairman of the supervisory board of their university hospital, have little means to advance the health policy of their commune? We must have a discourse of truth about the state of the public hospital in France. The CHUs are almost all in deficit despite a financial endowment 30% higher than that of the private sector.
I call for an ambitious reform of the hospital and health around a better distribution of competences between local authorities and the State. For this, the strategic state must focus on essential missions. It must first relaunch medical research and innovation, necessary to build excellence in the care of the future, health technologies and support for addiction. I remind you that in 2010, the Large Loan had allocated 3.4 billion euros to these subjects. Currently, French medical research is stopped. France, which was 5th in the world, is now 8th in terms of research publication. In terms of our population, France is 25th worldwide and 16th European. Medical research and health innovation are currently divided between Inserm and the management of hospitals which use research as an adjustment variable, not taking advantage of the 15% of their budgets that should be devoted to it. This budget must be secured, recreate the CHU by integrating Inserm and leave biological research to the CNRS.
The State must also reinforce the financing and the assumption of responsibility of the care by a system of modern and fair contribution. It must encourage the development of a public prevention policy and upgrade emergency services in all hospitals. Doctors must also regain power over administration within the CHUs with the establishment of co-management with a doctor / director pair.
Finally, local elected representatives must be responsible for developing a local health plan by directing a local health council intended to coordinate action between the public hospital, private operators, city medicine, nursing homes , Laboratories. The ARS, and this is not a criticism against those who work there, demonstrated that they were not the relevant level. Communities must now have their hands free to establish a real local health plan, to build a local medical policy in a global way, with multidisciplinary health houses guaranteeing better access to care, using new technologies to fight against white areas and medical deserts, and thinking of a new emergency offer which combines Sdis (Editor's note: departmental fire and rescue services) and city medicine. It is with local elected representatives, actors involved in the health management of their territories, that our country will acquire a more efficient organization, capable of facing the crises of tomorrow.
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This model works perfectly in many European countries that have more effectively coped with the Covid-19 epidemic. Let's not wait any longer to implement it.