he challenge is all the more difficult since the latest trends of societal evolution, trends which are irreversible at least in the short term: aging population, medical desertification of part of the territory, the feminization of the medical profession, increased long term diseases, shift of the paradigm on the place of work as compared to balance of life..; The observations were made and remade and I will not repeat all these aspects except perhaps on the question of political ideologies.
Indeed, we are in a world where policies are decided based on ideologies from the 18th and 19th centuries, compiled from a society that no longer exists: the political cleavage « right-left » whose policies are virtually interchangeable , are in my opinion the most striking example of this vanished world which was less complex than it is today. A new policy approach has yet to be invented, based on society as it is and not as it was. This would avoid a lot of strategic errors such as the law on the 35 hours in a context of scarce financial and human resources. Even if this law and the desire to work less are legitimate, it was based on the needs of another era.
What might be the bases of this new political ideology (meaning a structured system of thought): First the reaffirmation of respect of the human life and the environment, generally speaking what is alive. This leads to the question of health care of immigrants, an immediate and crucial problem; then the reaffirmation of the support by the community of people’s physiological needs and security, namely the management of individual health problems depending of his/her resources (not only financial).
Several key questions arise here:
At the level of the definition of the concept of security. Should we continue spending large budgets on armaments while it has become increasingly sophisticated and that the so-called conventional war has disappeared? Could we not transfer these budgets to Health? Should not the question of military defense be supported at European level? If so, what Europe (which countries?)? In other words, how to define security today between security of a territory (but with what border?) and safety of people and their health in a world where resources are scarce and technologies sophisticated?
The level of support by the community which would support the needs of those who cannot access the health system, either by lack of resources or lack of doctors. The principle would be that of equity: access to care for all and according to his/her own possibilities.
The public service principle has to be reaffirmed in the field of health:
(I) The public hospital is the heart of the health system but it encounters difficulties due to firstly strong syndicalism of the medical profession that places corporate interests before those of the community and secondly the technocratic and non-transparent management of regional health agencies whose belief system is liberal (obsession of cost savings which favours projects with less efficiency in terms of patients’ care; no evaluation of public policies especially in “Ile de France”, few staff without no real vision or background in public health policy deciding for an entire territory, strong lobbying of doctors ….).
(Ii) That leads to the reform of the public service, (again a legacy of the past in France), for a better public service.
(Iii) in terms of maintaining the public service, should we ask the medical community to devote part of their time to the community, to those who cannot access care? When will the patient electronic records be introduced that seems so complicated to set up in France?
As you can see there are many questions and choices which are linked to the values of a society. And in the absence of political vision, we can only reaffirm our commitment to the notion of humanism and what ensues.