France: When Health Care Is Downsized by Austerity

Translated Sunday 15 April 2012, by Gene Zbikowski and reviewed by Bill Scoble
L' Humanite
April 15, 2012

In mid-March, the unions at the teaching hospital in Toulouse learned of an “anti-crisis performance plan.” On the menu: grouping, outsourcing of services and reconsideration of the pertinence of health care acts. It is an austerity plan that conceals its name and endangers the provision of health care.

“Don’t let the crisis enter the teaching hospital without forewarning.” Management’s “anti-crisis performance plan”, which was presented in mid-March to the Committee on Hygiene, Safety and Working Conditions (CHSCT) of the Toulouse teaching hospital, has put all the staff on alert. It talks, pell-mell, about “restructuring”, “grouping”, “the proper distribution of staff”, “the organization of work”, “the outsourcing of services”, “optimization”… It is an austerity plan which conceals its name, but which is all the more alarming as, for the past few years, the staff at “the best teaching hospital in France” have been subjected to many restructuring projects and “the setting up of mechanisms to ease the breaking up of the public hospital,” according to the CGT union.

Emilien Abbal, the coordinator of this great “anti-crisis” plan at the teaching hospital, tries to be reassuring: “We want to anticipate the reduction of the hospital’s resources, foreseen in 2012, in the interest of the patients. Not doing anything would allow the hospital to go into decay.”

This talk is not at all reassuring to the CGT union at the teaching hospital, which is particularly concerned by the chapter on “the pertinence of health care acts.” According to the “anti-crisis” plan, management is indeed rethinking “the pertinence of expensive therapeutic acts and/or the narrow or uncertain therapeutic margin.” For Emilien Abbal, it is “just a matter of not dispersing money and thus avoiding doing the same examination twice, the over-consumption of health care acts that do not add anything, etc.” In sum, it is a matter of “improving productivity in the best sense of the word.”

Julien Terrié, the deputy general secretary of the CGT union, interprets this orientation differently: “For us, there is something more. Aren’t we going to wind up reacting to statistics on the rate of cure, as in Great Britain? We know that this is the beginning of the slippery slope.”

Selecting patients as in the private sector.

“With a plan that defines the pertinence of health care acts, one may ask oneself if we’re not going to select patients, the way the private clinics do,” points out Cécile Pomies, the secretary of the CGT health care union in the Midi-Pyrénées region of France. “Of course, the question of pertinence must be raised, but it is very dangerous to approach it from the angle of cost management, because in that case, people’s health is endangered.” A turn in orientation that the management of the teaching hospital denies: “What we want is to avoid reducing health care provision, the better to distribute it and to avoid having to arbitrate among the patients. In no case are we talking about profitable and unprofitable patients.”

A logic of cost management.

Yes, but under what conditions? “They tell us: ‘There’s a crisis and we have to anticipate it.’ Except that we’re already in a crisis from the point of view of the workload. The rate of occupation of the beds is nearly 100%, we don’t have any margin of maneuver in terms of staffing levels. Just last year, over 20 cases of imminent and serious danger were filed with the CGSCT, for example! In all of the wards, we are confronted with worsening problems, and this plan isn’t going to help at all,” said Julien Terrié.

Although in Toulouse “we didn’t expect this,” the anti-crisis plan is not an isolated strategy. It is the local consequence of national directives. Today, “efficiency” and “cost management” have become the government’s leitmotiv in health policy. Thus, in a “strategic guidebook” intended for regional health agencies (ARS), the general office for health care provision (DGOS) indicates that in the coming years’ financial constraints must henceforth be anticipated: “The setting up of regional schemes for the organization of health care (SROS) must be realized in a context of continual tightening of financial constraints, constraints which will be applied to every sector of health care provision.” This means that the SROS is to become the tool of choice for the rationalization of health care provision. Since it is no longer possible to lower government financing despite increased activity or to increase employee productivity, the solution is an overall reduction in capacity in the provision of health care.

“A health catastrophe”

The CGT union at the Toulouse teaching hospital “will fight against the adoption of the anti-crisis performance plan.” Julien Terrié, the deputy general secretary of the union, repeats that “in the present context, the solution does not lie in austerity and a reduction in health care provision. A plan like this one amounts to a health catastrophe for a metropolitan area of 850,000 inhabitants. The hospital, patients, health, territories law (1), financing according to activity (T2A) and government policy endanger the provision of health care in the entire Midi-Pyrénées region.”

(1) The hospital, patients, health, territories law is the official name of a law presented in October 2008 by Roselyne Bachelot, the Health minister. The law is the first stage of Nicolas Sarkozy’s Hospital 2012 Plan, which aims at revamping the health care system.