France re-engineers healthcare system
Reform of the French healthcare system was placed on a fast track for legislative approval that turned into a six-month marathon of debate punctuated by several street demonstrations.
John Brosky reports
But by the end of June, Health Minister Roselyne Bachelot won approval of the law Hospital-Patients-Health-Regions (HPST; Hôpital, patients, santé, territoire) that restructures the healthcare system in France and gives new executive powers to both hospital directors and regional health system directors. (See European Hospital, Issue 02, 2009, “Non! to super-CEO”).
The French parliament split along party lines in approving the final text, assuring victory for President Nicolas Sarkozy’s Union for the Presidential Majority with a 174 to 154 vote in the Senate and a comfortable 179 to 117 result in the National Assembly.
More than 10,000 amend-
ments were proposed and debated with the final law expanding to 135 articles from the original 33 articles proposed by Minister Bachelot.
Yet, despite the sound and the fury, and in spite of being weighted down with an additional 102 amendments, few changes of substance were made to the government’s plan for reform.
To assure President Sarkozy delivered on his provocative promise to bring American-style management to French hospitals with a “super-CEO”, in a rare legislative stunt his health minister introduced an amendment at the last possible minute to reassert the decision-making power for hospital directors over internal medical committees, erasing with a single stroke weeks of debate and compromise driven by pressure from the medical community.
This 11th hour amendment, approved without debate in the final vote, requires hospital directors to merely “discuss” significant decisions with various hospital committees and removes a more restrictive Senate text requiring directors to “seek the opinion” of internal groups, such as medical directors, nurses and patient care committees.
The Senate took up the cause of the medical community that sponsored several street demonstrations during debates, which included, for the first time in recent memory, participation by the great “Mandarins”, the heads of leading French medical institutions.
These demonstrations offered charming moments on national television as prestigious doctors and surgeons were taught the basics of protesting and given practical instruction on what to wear to a demonstration – for their good health.
“This law is not founded on the healthcare needs of the population, it is only the needs of management that have prevailed”, said Deputy Marisol Touraine, who led the Socialist Party’s opposition throughout the legislative marathon. She said opposition parties will seek a revocation of the HPST law from the Constitutional Council, though no one expects this manoeuvre will have any meaningful effect.
“French hospitals today reflect perfectly what can go wrong with French bureaucracy,” said Guillaume Sublet, head of Economic Intelligence and Regulatory Affairs with Nextep Consulting & Health Economics in Paris.
“The government made it clear from the beginning that the paralysis, even sclerosis, in decision-making must be the priority,” he said, adding that the newly empowered super-CEOs no longer needs to reconcile the diverse and often conflicting opinions of a half-dozen committees to move a project forward.
“Now, for good or for ill, the quality of decision-making will depend heavily on the intelligence and competences of the individual hospital directors,” said Sublet.
Also receiving new executive powers will be the directors for the restructured Regional Hospital Agencies. The new name of these organisations, Regional Health Authorities, reflects the shift in the government’s reform from a hospital-centric model to one focused on a system for patient care that integrates and coordinates service delivery by both public and private clinics across a given area in “territorial hospital communities,” as well as coordinating services of diverse state agencies and the statutory health fund.
The four pillars of the HPST law address modernising health establishments, enhancing access to high quality care, initiating new public health awareness and prevention programs, as well as creating the new health authorities.
01.07.2009
