Reforming the hospital sector in France: comparison with the 2009 Bachelot Reform, the 1996 Juppé plan, and the 1958 Debré Reform

Résumé du document

In order to understand well about how the hospital sector in France works, I would like to highlight its main features. This sector is not based on a single plan which was decided at a given time, but was reviewed at many occasions so as to improve its management, its cost-effectiveness and its territorial steering. Indeed, the hospital sector was formally created by the 1941 law which founded the modern public hospital. Since 1941, hospitals were not anymore only a way to rescue the poor and impoverished people, but the hospitals had to support the sick people of all the social classes. In 1958, the Debré reform that I will confront with other reforms, created the CHU (Centres hospitaliers et universitaires) which really revolutionized medical education because it organises hospital as a health care center, an educational center and a research center. We will see in this Hausarbeit, how the constitutional nature of the ordinance is well-used by the governement to implement a law without taking care of the veto opportunities and sometimes the medical preferences.

Extraits

[...] The best use of the media coverage could be seen during the 2009 Bachelot reform where some well-known physicians and hospital actors signed up the “Appel des which was clearly a text against the law. As in the daily press, it mentioned the of the public service” and the birth of a “mercantile health care system”. The goal here was to claim the negative sides of the reform with an argument of authority: these well-known physicians such as René Frydman and Olivier Lyon-Caen have more potential to be listened and believed than the government experts. [...]

[...] www.lemonde.fr www.liberation.fr www.sauvons-la-sante.com http://www.cnps.fr/ http://www.csmf.org/ HASSENTEUFEL, Patrick Vers le déclin du pouvoir médical ? Un éclairage européen : France, Allemagne, Grande-Bretagne, Pouvoirs : 89, 51- 64. [...]

[...] If the juridical means used was the ordinance, it was not in particular because of a matter of emergency. It was done to move away the important medical lobby from the parliamentary decisions above all. The medical elite were indeed very well-representated in the Chamber of Deputies, according to Jean Dausset, in the letter he published for the 50th birthday of the creation of the C.H.U. He said that it was so likely that the law would not have been implemented without this “extraordinary combinaison of circonstances”. [...]

[...] Indeed the hospital sector was formally created through the 1941 law which founded the modern public hospital. In 1941 hospitals were not anymore only a way to rescue the poors and impoverished people. Since this law, the hospital has to support the sick persons of all the social classes. In 1958 the Debré reform that I will confront with other reforms, created the C.H.U. (“Centres hospitaliers et universitaires”) which really revolutionize the medical education because it organises hospital as a health care center, an educational center and a research center. [...]

[...] Concerning the 1958 Debré Reform, it is not the same atmosphere: this reform concerned the medical elite and could not attract public opinion and a great mobilization. The 1996 Juppé Reform, with the creation of the regional hospitalization agencies, which reduce the autonomy of the profession, created as the 2009 Bachelot reform one of the biggest mobilization the country have ever known. The media could be clearly associated with the capacities of the trade-unions to mobilize the public opinion The power of the media Media could also highlight the medical dominance. [...]