Our health system works on the head. Instead of from the needs of the French, there is a built in function of the existing supply. Instead of learning from the experience of personal health, it is designed " from above ", according to rules that are far from the reality of daily life.
"Segur health" offers an exceptional opportunity to reverse the priorities at the price of an overhaul of the whole system in the developing from its roots up to its roof ridge. Is it just structural reforms and financial, as wide as they are, without change of logic, and without giving a political direction clear, the objective will be missed.
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The five examples of the following routes will need to bring the "Ségur of health" to answer questions that they raise :
Emma, suffers from a rare disease. Stakeholders : family, helping familiar (auxiliary of life), health care aide, home occupational therapist, referral pathways health, a provider of in-home services, county council, doctor, centre of reference, and sector of rare diseases.Paul, dependent elderly person GIR1 in long-term care facilities. Stakeholders : health care aide, nursing, physician, social worker, maison départementale of persons with disabilities and county council.Jules, waiting for a home chemotherapy. Stakeholders : care service nursing home, nurse coordinator, medical oncologist, general practitioner, centre for the fight against cancer.Fatima, emergency 22 hours, lives in the area, sub-dense. Stakeholders : home care and home health care multiprofessional, emergency department, the departmental service of fire and rescue, tele-consultation.Gérard, type 1 diabetic. Stakeholders : family, housekeeper, nurse coordination, nutritionist, general practitioner, remote monitoring, diabetologist, department of diabetology.How to transform the system ? Here are nine key proposed to meet them :
1. Focus on assisting overall daily
It is in the home, in businesses, administrations and public services within municipalities in the area and in the medico-social establishments it is necessary to improve the daily health of the population. Based on the real needs of patients and their experiences of the disease, collectively we need to rebuild the organization and governance of the health system and, finally, to recognize the role of all actors, whether from the school or businesses.
2. Out of the all-medical
The vision from "above" emphasizes an analysis of the route only by its therapeutic aspects. However, the follow-up by doctors, whose expertise is paramount, is rarely required throughout the management of patients. It is therefore necessary to appeal to allied health professionals and pharmaceutical competencies, trained to the work of the team and the new opportunities offered by the digital. Regularly assessed, deployed in the territories at the service of the course of patients, these professionals will be involved from prevention to care and rehabilitation.
3. Bring together the health professionals
The care cannot be exclusively evaluated on the basis of the practice is purely medical. The coordination of the health care team should help to ensure the comprehensiveness of the care of patients. In very many situations (disability, dependency, insecurity), the action to be undertaken is comprehensive, medico-social, appealing to all professionals involved that need to work in teams.
4. Let the creativity of our teams thrive
If the skills of the health professionals have acquired during their initial training, it is crucial to take into account the gained experience. An auxiliary of life will have a particular acuity to recognize weak signals ' which help to guide choices medical. A nurse of advanced practice will assume functions of coordination, evaluation and assessment of certain requirements. A pharmacist will assess medication therapy best suited. The autonomy of professionals, institutions but also of the territories becomes the cardinal point of the new organization as opposed to a current model where the regulation and supervision "from a distance" shall prevail. In this regard, a massive investment in digital should be operated to allow for these new logics of cooperation and sharing.
5. Define a governance by rethinking the organization and management on the ground
The governance teams must think locally and rely on the trust and recognition of the know-how. The current management is more focused on the single administrative management of human resources that the accompaniment of the sick and the talents of professionals. The decision-makers, health depend on the regional agency of health (ARS) and the CPAM, and those of the medico-social department of the council : it is necessary to unify the actions involving strongly the areas in the health policy and by empowering them financially. They coordinate the actors via the ARS in which they will control.
6. Offer the freedom to act
Accept the differences is to recognize that the health needs are not identical in all territories, or between all the social categories. It is time to move on from the State manager to the State guarantor, if one wants to stop the entropy of organisational and financial, which contributes to the deterioration of the system. The ability to innovate and experiment must be recognized, and freedom must become the rule.
7. Streamline the funding
in Order to be able to quickly put at the disposal of human and budgetary resources that meet the expectations of professionals and patients, it is necessary to put in place funding as close to the ground, in line with the logic of team work. The intervention Fund regional, calculated on a basis of population, must become the priority of ARS. These funds cannot be used for other objectives, including financial (debt settlement establishment, for example).
8. Graduate access to care from prevention and primary care to the hospital
The care team involved daily with the patient, the need in medicine of the city will be more spaced in time, particularly in the context of chronic pathologies. The management of the health system from its base paramedic will use all the intermediate resources (home health pluriprofessionelle, guard house, hospital proximity, telemedicine...) in graduant access to book the clinical situation more complex superspécialistes hospital liberals and mobilizing the technical equipment of heavy.
9. Not to think in beds, but in network
The bed is a unit of value obsolete within the hospital. It is its quantity which describes the financial weight of 3 000 hospital facilities (35 % of health insurance expenditure). Got rid of his race to the gigantism and the multiplication of institutions, the hospital will focus its financial efforts on research and medical excellence.
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Cedric Arcos, a lecturer in health policy, Sciences Po, Paris.
Didier Bazzocchi, vice-president of the CRAPS (centre for research and analysis on social protection).
Philippe Denormandie, surgeon.
Olivier Mariotte, doctor, entrepreneur and local councillor.
Vincent Olivier, the director of Recto-Verso, consulting company in health.
Benedict Péricard, president of an association medico-social.
Guy Vallancien, a member of the Academy of medicine.
