Nice symbol. One year to the day after Edouard Philippe's speech at Eaubonne, to boost the "Transformation of our health system"Agnès Buzyn presents this Wednesday in the Council of Ministers his bill. He must set to music the strategy defined on September 18 by Emmanuel Macron. Focused on the structuring of the local healthcare offer and the redefinition of the hospital card, this major project was then rather well received by professionals in the sector, convinced of the need to reform quickly and consensually.
At present, some are gray mine. The young doctors, behind the ReAGJIR trade union, take offense at finding nothing in this text about the beginnings of a medical career. Frédéric Valletoux, at the Hospital Federation of France, suspects the technocracy to have seized a beautiful project to pass it "At the mill" : "The promise of transformation of the health system is not obvious, it is a project much too hospital-centered"he's disenchanted.
"We are worried because this bill, if it looks in the right direction, lacks precision and sends out too many topics out of the parliamentary debate"adds the president of the College of Physicians, Patrick Bouet.
A tight and urgent text
This relative disappointment has a lot to do with the urgency with which the bill was conceived. To allow reform of medical studies from the start of the 2019 academic year, it was necessary to move forward very quickly. The administration has drafted a tighter text of 23 articles. He will arrive at the National Assembly in Social Affairs Committee on March 12.
As if to put the importance of this text into perspective, Agnès Buzyn declared that she did not want him to bear his name. And in fact, much of the transformation of the health system will happen outside this law after consultation on each topic with stakeholders in the sector.
Two conventional negotiations are in progress. Firstly, in view of an interprofessional agreement to define the role and funding of the future territorial occupational health communities (CPTS), to which all liberal doctors will ultimately have to adhere. Second, to reach an amendment to the medical convention to recruit "medical assistants". The discussion between the doctors' unions and Medicare is also stormy, the latter being accused of pushing to "productivism".
Nearby hospitals still unclear
Equally important are the six orders that can be made by the government following the vote on this health bill, which is also an enabling text. The recertification of doctors, the creation of the unique status of hospital practitioner, the baptism of "local hospitals": none of these texts is still known.
In Agnès Buzyn's office, there is no mention of the number of local hospitals or the amount of additional funding that will be granted in the coming years. "Will they have a shelf of radiology, biology; can the private sector manage it and in this case what will be the public service obligations: we do not know anything »regrets Frédéric Valletoux, who would have liked the government to propose all texts simultaneously to "Measure consistency and effectiveness" of the reform.
In addition, they are decrees that will say by which the national classifying exams and the first year common to the medical studies will be replaced. Lastly, the reform of the activity authorization system, which is so important for restructuring the hospital card, can partly be dealt with by ordinance, but will essentially be regulatory.