According to a February 2017 Harris Interactive survey, two out of three French people no longer have confidence in the future of the French health care system. Will the appointment of Mrs. Agnès Buzyn to the Ministry of Health herald a new era of concrete solutions to improve patient care, decongest the hospital and get out of the medical deserts? Will it enable medical procedures to be valued over the long term (price and quality of consultations)? The Federation of French Doctors is calling for a "Marshall Plan" to save the French healthcare system. Interview with Jean-Paul Hamon, President of the FMF, as he is received today by the Minister.
UP': What do you think of the appointment of Mrs Agnès Buzyn as Minister for Health and Solidarity? Do you know her?
Jean-Paul Hamon: Not only by reputation. I had heard her from afar when my fellow student Jean-Luc Harrousseau left to take over as head of the HAS. Those of my union who met her say good things about her and in any case the FMF has no preconceived ideas and is looking forward to meeting her.
UP': What messages is your Federation receiving with this appointment?
JPH None. She's a smart woman with a resume that speaks for itself. It is hoped that she will use her intelligence in the service of a much-needed reform of the French health care system.
UP': Does the term "solidarity" in the title of this ministry give some hope to the concerns of the Federation of French Doctors, faced with the desertification of doctors' surgeries in rural or isolated areas, the concern to secure and improve patient care and the loss of freedom of so-called "liberal" medicine?
JPH: Solidarity is understood to be for the benefit of the patient, which is not a bad thing in itself.
Medical deserts are finally in the presidential debate, and it's about time because Paris has lost 20% of its GPs in ten years and whole regions like the Centre and Normandy are already medical deserts.
Liberal medicine needs to be made more attractive again: only 9% of graduate doctors settle in the first year and 40% take 10 years to settle, whereas 30 years ago, 60% of doctors settled as liberals. We also need to make sure that students know about liberal practice when they go to school and that they are not afraid to settle, that doctors can work properly with proper staff and proper facilities and that they are encouraged to accommodate the 15 million non-emergency visits that cost the community $3 billion.
The hospital and the city need to be able to communicate in real time and to develop the secure messaging that is favoured by 70,000 doctors (apicrypt) rather than struggling to deploy an expensive and unused Personal Medical Record.
UP': Do you approve of the Dutch President's health programme? Because even though there have been more nursing homes created, drug prices have fallen, improved access to contraception, extension of the plans against neurodegenerative diseases, cancer, autism, ...
JPH : The presidential programme has benefited from skilful communication but apart from that the effectiveness is more than limited... the policy led by Marisol Touraine was a disaster and France lost five years. It had started well with the treatment of abortion at 100% but it is the only positive thing because free contraception for teenagers is of a rare complexity and is unusable. Marisol Touraine has stigmatized the liberal doctors, she has made the bed of the mutual insurance companies, the patients pay more and more and are less and less reimbursed. Third party payment will be of rare complexity and doctors who already widely practise social third party payment will refuse the generalised and compulsory third party payment.
UP': You call for a fair, equal and sustainable health care system. What are your first demands?
JPH: o Equal access to care, i.e. finding a doctor easily.
o To be able to obtain specialist appointments within a reasonable timeframe.
o That patients are properly reimbursed for their care
o Guarantee the attractiveness of local medicine and have a genuine collaboration with the hospital.
UP': 100 % for eyeglasses and hearing and dental prostheses, 5 billion in investments for health (which some liberal unions already fear will only be allocated to hospitals), a compulsory health "service" for health students to carry out prevention in schools and professional establishments, the reinforcement of the right of patients to be forgotten and the doubling of the number of health centres, a generalisable rather than generalised third party payment system, an end to activity-based pricing in hospitals, the introduction of grouped purchases of innovative medicines at European level, etc. These are some of the proposals of the new President of the Republic. What do you think of them?
JPH: The coverage of dental prostheses is a good thing, but it would be preferable to reimburse the prevention acts at their fair price by making the patient who does not make his prevention consultations responsible: 2 prevention consultations at 90€ per year and if the patient does not make them he pays for his prosthesis.
There are enough savings to be made in order to invest in both private practice and hospitals: the unification of all social security systems, the elimination of the EUR 8 billion in management costs for mutual insurance companies and the EUR 15 billion in excess hospital expenditure compared with our European neighbours, the adjustment of ASMR 5 drugs, the marketing of Avastin instead of Lucentis would save EUR 400 million (we have lost EUR 2 billion in this case alone). It also involves the abolition of the so-called prevention centres of the social security system which do not treat a patient: they only provide a prevention consultation, the Court of Auditors has pinpointed them by saying that "they did not reach their objective", a euphemism which costs the State 200 million euros, not counting real estate.
We cannot continue to talk about prevention and laminate occupational medicine, as was the case in the Labour Law.
UP': What do you expect as major innovations from this ministry, such as the development of telemedicine proposed by Emmanuel Macron?
JPH: Before talking about telemedicine, let's start by introducing broadband throughout the country!
UP': You said on May 2 in a business magazine that "the risk of statism with Macron was bothering you" because "he has surrounded himself with public health specialists". Can you explain yourself?
JPH: It's simple: there were no liberal doctors in his entourage! I hope that Mrs Agnes Buzyn will not wait the last six months to take a liberal doctor among her advisers...
UP': What roadmap do you want to give Agnes Buzyn?
JPH: I wish him courage and to finally redefine everyone's role, so that the hospital no longer leaves its walls and has the means for hospitalization. Before leaving his ministry, Jean-Marc Ayrault had said in Grenoble: "that the Hospital no longer do what can be done in the city" that would free up staff for hospitalization! "I also hope that local medicine will become attractive again in order to put an end to medical deserts, and that it will require real-time communication between the city and the hospital: patients need secure care.