Why France is planning a massive overhaul of its healthcare system

Why France is planning a massive overhaul of its healthcare system
French hospital workers have long been protesting to achieve higher salaries and better working conditions. Photo: AFP
French President Emmanuel Macron will on Monday present the first part of the government’s plan to reorganise France’s much-vaunted healthcare system.

The stage is set for the launch of the beginning of what French media has described as “perhaps the most important moment” of Macron's presidency.

This is the opening of a seven-week long consultation with healthcare professionals, which will form the backbone of a major overhaul of France's hospital and community health system.

“We will act fast, we will act strongly,” health minister Olivier Véran said as he announced that the government would enter this process in an attempt to meet hospital staff who have long been protesting about low pay and poor working conditions, problems exacerbated by the coronavirus crisis.

Among the most pressing topics to be discussed during the Ségur de la santé – the name of the process has been taken from the avenue de Ségur, the street in Paris where the health ministry is located – are salaries, working conditions and general organisation of healthcare services in cities and rural areas.

For the first time since Macron entered the Elysée Palace all of these topics will be on the table, after the president himself admitted that the government made a “strategic error” when pushing forward the 2018 health plan, which aimed to continue a longstanding process of rendering hospitals more efficient.

“We will shake up corporatism, habits, inertia. We will be transgressive if necessary,” said former neurologist Véran, promising that “nothing will be the same.”

The government's plan to redefine the health system contains four pillars;

  • Reevaluating salaries
  • Defining an investment plan to reform the way hospitals are currently financed
  • Rendering the system more flexible and simple
  • Rethinking the organisation between city and rural area and doctors and hospitals

The results of the Ségur de la santé will be part of a new social security law that will be presented to the parliament this autumn.

French Health Minister Olivier Véran has promised a shake-up of the current health system. Photo: AFP 

Salary increase

Although the French hospital system is regarded as one of the most generous and best in the world for patients, nurses in France are currently among the worst paid in Europe and they have been protesting about their low wages for years.

The government’s coronavirus bonus (€500 for most staff, €1,000 for some), fell victim to harsh criticism by most of the country’s hospital sector and hospitals are now asking for €300 more per nurse a month – 200,000 nurses in total – along with an 20-30 percent salary increase for doctors.

Union representatives have said they remain convinced that the government will meet their demands of a general salary increase, and government officials themselves have over the past week on several occasions indicated to French media that such a raise is indeed on the books.

READ MORE: How do nurses' salaries in France compare to the rest of Europe?

Working hours

Changing the rules on the number of hours nurses and other hospital staff work will be a main point of disagreement between unions and the government in the coming weeks.

In an interview with the French newspaper Journal du Dimanche, Véran said he wanted to “render more flexible” the rules regulating working-hours, to make it easier “for those who wish to” to work longer.

Some argue that French nurses earn less because their 35-hour week is shorter than those of for example their German colleagues.

Unions slam this as inaccurate, and say that French nurses are obliged to take extra shifts to top up their too-low salaries, and that increasing their hours would only worsen the existing situation.

“We need to create more jobs in order for everyone to be able to take the days off that they have the right to take, as they, right now, often can't,” said Thierry Amouroux, union spokesperson for SNPI, to Les Obs.

They are asking for 20,000 new hospital posts.

Could the coronavirus crisis be the turning point nurses have waited years to achieve? Photo: AFP

Reorganising the system

In November French government spokesman Sibeth Ndiaye told members of Anglo American Press Association including The Local, that while she had sympathy for medics who at the time were taking industrial action, she believed this was not the way to go about raising questions about the French health service.
 
She said: “President Macron does not want to make small changes and put small amounts of extra money into the system, but instead we need systemic reform.”
 
The government's current plan will include a review of the organisation to improve and strengthen decentralised health services, evaluating steps that can be taken to prevent illness rather than just treating the disease.
 
Not new
 
For decades, French governments have, along with governments across the developed world, striven to rid themselves of healthcare costs by turning hospitals into more profitable, more efficient businesses, favouring short-term services over costly long-term care.

Hospital workers in France have been organising street protests for months to get the government's attention.

In the winter of 2019, barely three months before the coronavirus stretched many hospitals virtually to breaking point, nearly half of France’s public hospital services were on strike (a largely symbolic label as actual walk-outs in the public hospital sector are forbidden by the law).

“Public hospitals are collapsing,” read a joint statement published in November in Le Monde newspaper by 70 public health chiefs from Paris hospitals who feared the crisis was reaching an “irreversible breaking point”. 

In January, over 1,200 health officials resigned from their administrative duties in protest.

The coronavirus pandemic – by forcing the government to slam down a strict, nationwide lockdown in order to save hospitals in hot-spots from buckling under the mounting pressure – gave staff the attention they have been craving for years.
 
Now they are hoping for “a substantial gesture” from the government as compensation. As Le Monde stated in their editorial on Monday, “the anger is so big that he (the president) is no longer entitled to mistakes.”
 

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