samedi 20 mai 2017

Let us unblock our french healthcare system through the free choice of an insurer and a contract

"At the end of breath", it is the leitmotiv of the actors of the care. But the system is not dormant. The state and its health insurance monopoly are more powerful than ever. Both decision-makers have large financial resources up to 12% of GDP. But what is not working? What is the diagnosis?
From the scissors effect between the scarcity of the medical supply and the infinite demand, free of charge, from galloping bureaucratization to numerical inorganization, from expenditure authorized by the state by a goal rarely respected to the deficit, one understands the contradictions Which affect the efficiency of our health care system. Two central questions arise.
Who is at the origin of the structural changes that led to this chaos?
Who is the unique actor of this adrift system?
It is easy to answer the first question but it is a taboo that forbids us to think. All these decisions are made by successive governments and their administration. An emblematic example of the number of students admitted to medicine; Not only since 1971 year of the first numerus clausus the state never doubted but one continues to believe, persevere diabolicum. Does this mean our officials are bad? Of course not, no more in any case than those outside the Rhine or elsewhere Léman.
Do not bite off more than you can chew. The French state wants to decide everything from Paris in an egalitarian Manicheism that loses and destroys the fabric of care. The treatment is simple: a more intelligent state. The health care system is in some ways exceptional, but it relates to the content of its mission and not to the exemption from the basic economic rules. The treatment of this hyper-regulation which feeds a self-employment bureaucracy is autonomy, massive deregulation, and financial responsibility. Fewer administrative structures, fewer non-nursing hospital jobs and a high level of management demand that begin with balancing accounts and tariff convergence. For outpatient medicine, the contract is sufficient to regulate activities and demand. These contracts that the state will have framed by the law but which will replace advantageously a single convention.

The answer to the second question is equally taboo. It is the administration of social security that false nose of the state called paritarianism without financial responsibility which is alone to the levers (262 billion in 2015). It must assume its responsibility in a triple failure to several billion: "vital" card reduced to a debit card without debit, an electronic medical record not shared because nonexistent and telemedicine reduced to video conferences. The treatment, here too, is simple is a certain amount of competition. The security sector needs organizational innovation to converge existing resources and demand. According to his political leanings, one can resort to the competition of the caisses or to the opening of the health insurance to all the qualified actors because the innovation feeds on the differences. There is another advantage to competition, insurers in both cases will offer baskets of care. The insured will finally know what he is paying and what is the content of the contract. He will have to insure himself for the major risk, but he can choose to save the part of the premium that reimburses thermal cures, transport, daily allowances excluding an accident or serious illness, non-exhaustive list. Thus the reduction in social security contributions will not lead to an increase in public indebtedness but to an increase in purchasing power. There will be clarification where today there is connivance to the detriment of the insured due to the complexity of repayment rules and premium inflation.
Electoral debates speak so little about this, while the unblocking of our healthcare system is at hand like other countries in Europe.

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