Jean-François Mattei, Xavier Bertrand, Philippe Bas, Roselyne Bachelot, Marisol Touraine, Agnès Buzyn. All have passed through the avenue de Ségur, and all agreed to mention what should have been decided, or on the contrary not to be launched, in the past twenty years to avoid the current situation.
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“All our health system is out of breath.” It was when taking office, in July, that the new Minister of Health and former Emergency Chief of Metz-Thionville Hospital , François Braun, drawn up this alarmist observation. The shortage of doctors, nurses and nursing assistants has already caused, in the first days of summer, the degraded closure or operation of more than twenty emergency services in the public sector.
To go back to the roots of this deep crisis in the hospital system, Le Monde questioned several of the health ministers who have succeeded in the past twenty years: Jean-François Mattei (2002-2004), Xavier Bertrand (2005-2007, then 2010-2012), Philippe Bas (a few months in 2007, but also Minister for Social Security from 2005 to 2007), Roselyne Bachelot (2007-2010), Marisol Touraine (2012-2017) and Agnès BUZYN (2017-2020). We asked them, if it was to be redone, what reforms should have been initiated or on the contrary amended, to avoid the current crisis. All have a critical look at the health policy engaged since the turn of the XXI th century, but often less severe on their own assessment avenue de Ségur.
the numerus clausus or the Fall of the number of doctors
France estimates in the 1970s that it risks having too many doctors. A numerus clausus is then set up to limit the number of students admitted to the second year of medicine, without real assessment of health needs, starting from the hypothesis that the more doctors, the more prescribers there are prescribers And the more social security deficit is widening. The medical world also sees its advantage: containing the number of practitioners makes it possible to limit competition and guarantee income. The measure logically leads to a collapse of the number of doctors formed, with a decrease of almost 60 % in the mid-1990s.
“When I arrived at the ministry in 2017, says the former Minister of Health Agnès Buzyn, I knew that the health system was in tension. The first thing I asked for my teams was Show me the demographic projections. When I saw the curves, I was panicked. I saw that the retirements projected by doctors trained in the 1970s and the number of trained doctors made a V curve, In the next ten years. We had no way of maintaining the same number of doctors – already insufficient in 2017 – on the territory. “
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