Saïd Ouichou is a general practitioner, based in Marseille. He practiced in the
northern districts for fifteen years.
France, the best health system in the world in 2000 according to the WHO, is only in 16th place, far behind Singapore and Japan, now first.
This degradation of our health care system has been made according to political changes, through reforms dictated by considerations other than the quality of patient care.
However, alarm signals have been sounded several times without success.
Nothing resists this health policy which has decided to devalue the status of doctor.
The reform of the health system currently proposed is not likely to improve the situation.
Doctors will be replaced by teleconsultation booths.
The practice of certain medical acts will be attributed to pharmacies such as treating angina or taking smears.
Nurses will carry out medical consultations, reassess and renew treatments and prescribe additional examinations, although this requires medical expertise.
Indeed, why train caregivers in ten years when three years are enough!
After the year 2000, an imbalance took hold in the health system with a mismatch between the needs and the supply of care.
At its origin, the reduction in the number of doctors, the reduction in working hours, the aging of the population, geographical disparities and the imbalance between specialties.
The search for a better standard of living has made specialties less attractive than, on the other hand, on-call duty, night shifts, the arduous nature of the work.
The effort demanded of caregivers with a constant or even reduced workforce to ensure a growing workload is becoming more and more unbearable.
Work stoppages and burnouts will follow.
The situation in hospitals is deteriorating.
They experience an impoverishment of services.
Once again, accounting logic got the better of the quality of care
Said Ouichou
For 20 years, the number of doctors has been steadily decreasing, the result of an increasingly low numerus clausus, originally intended to stabilize the number of students in their second year of medical studies.
It becomes, year after year, a tool for the elimination and restriction of health actors.
This restriction is not going fast enough, we will encourage general practitioners to retire prematurely at the age of 57 by benefiting from the MICA allowance (Incentive Measure for Cessation of Activity).
The objective being dictated by the mathematical formula: fewer doctors = fewer prescriptions = less health insurance expenditure.
This is the entry of chartered accountants into health governance.
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At the same time, the population is naturally aging, but in poor health.
The average age of dependency in France is 62 years against 74 years in Sweden for example.
Chronic, unanticipated illnesses put a premature end to people's autonomy.
Prevention, hitherto underestimated, does not have much place in the health system.
It represents only 2% of health expenditure against 3% on average in Europe.
This also explains the increase in the prevalence of diseases secondary to smoking, alcohol consumption and obesity, especially among young people and in disadvantaged areas.
The situation in hospitals is deteriorating.
They experience an impoverishment of services.
Once again, accounting logic got the better of the quality of care.
The new governance of the hospital, led by business leaders, introduces the criterion of profitability in the programming of care, with the appearance of fee-for-service pricing.
From now on, it is the receipts which will determine the hospital expenses.
Health becomes an object of consumption.
80,000 beds have been closed in 20 years, at the same time the population has aged and increased by 7 million.
If beds close for financial reasons, others close for lack of manpower.
Caregivers resign, student nurses stop their studies, the job becomes too hard and too poorly paid.
To save our healthcare system, it is time to focus on the women and men who carry our healthcare system at arm's length.
Said Ouichou
City medicine is no better.
Doctors are retiring, young graduates are fewer and fewer.
They are only 10% to choose to settle in a practice, and rarely in the hinterland.
Medical deserts are multiplying.
The French wait weeks for an appointment and travel several dozen kilometers to see a doctor.
To find an efficient, equitable and innovative health care system, our country needs a profound overhaul of the health system currently lost in an organizational and administrative labyrinth and not yet another reform drafted by public accountants.
This overhaul cannot be done against caregivers but should involve the entire medical profession.
City medicine as the first resort to care must meet the needs of the population.
If liberal medicine does not survive this crisis, the family doctor will disappear.
It is urgent to inspire caregivers to continue to exercise this profession and to treat the French in complete safety, to revalue consultations and recognize the value of the doctor's work, to strengthen the link between city medicine and the hospital, to establish at the patient/caregiver ratios, encouraging young graduates to settle in medical deserts.
To save our healthcare system, it is time to rely on the women and men who carry our healthcare system at arm's length.
Bet, finally, on the soldier Hippocrates!