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Following the announcement of the candidacy of the President of the Republic Emmanuel Macron, we asked Dr Gérald Kierzek, emergency doctor and medical director of Doctissimo, to share his point of view on the current French health system.
Doctissimo: The candidate President draws up assessments and perspectives by post, in particular in the world of Health and Hospitals. Even beyond this letter, do you currently understand the past results and the challenges?
Gerald Kierzek: We cannot say that the results of Emmanuel Macron’s five-year term are substantial in terms of Health. There has been no revolution in prevention, the Ségur de la Santé measures are just sprinkling without systemic reform… I think we have to get out of this hyper-bureaucratized system, which is much too cumbersome senses. We must work with professionals in the field, re-medicalize the decision-making and organizational chain and overhaul all levels by reconciling efficiency and attractiveness. The five-year term has not been easy for Emmanuel Macron either with the crisis of the yellow vests, those of the Covid… I do not want to throw stones at him, he has also inherited 15 years of a technocratized system… But he it is absolutely necessary to carry out an in-depth structural reform of our health system. On this anniversary date of the law on patients’ rights, health is a major political, social and economic issue that can reconcile all French people, unlike many subjects that divide them.
Is France investing as it should in hospitals and research?
Gerald Kierzek: There is a real stall in France in these areas. We are for exampleand 21st among European countries in terms of drug availability time. This means a lack of availability for patients who need it. For the research and development budget, France devotes 2.2% of its GDP (Gross Domestic Product) to it, whereas Germany puts 3.2% and South Korea 4.6%. The salaries of the researchers are not fabulous either. All of this contributes to the current situation, when France has all the necessary skills and expertise.
About the hospital, why don’t the emergency services have a common objective which would be “less than 4 hours of waiting in the emergency room”? To better understand the hell of emergencies, read the testimony of the health economist Frederic Bizard who recently spent 21 hours in the emergency room following an accident on the public highway! Once again, we really need to change the software… and the computer scientists who created the software!
What past choices in terms of health would have, in your opinion, deserved another arbitration?
Gerald Kierzek: The dismantling of the health system. It is dramatic to reduce access to care so much, we need to have a local territorial network, it is essential. And we must renew the attractiveness of caregivers for their profession, they are volunteers, they want to work it is a vocation for many but they are not given the means. All this responds to the concerns of the French, it is a subject of social cohesion. And this will also make it possible to better face crises. The coronavirus crisis would not have had this magnitude if the hospital had had more resources and if it was better prepared for it. The impact would have been different. So let’s stop this ambulatory shift, open beds, where they are needed and give caregivers the means to do their job properly. Technology must come as a support, connected health cannot and should not replace everything. We must accept that today’s expenses will be tomorrow’s investments. We need a long term vision.
What does the aforementioned demographic transition mean, what are the issues?
Gerald Kierzek: The population is aging and yet life expectancy in good health is poor in France, it is around 65 years. However, the elderly live and need reception facilities. Better aging is also one of the major issues in France today. We must give the means to our health system to take care of them. Again, these are changes that won’t pay off immediately, but in 20 or 30 years it will have paid off.
Is reducing dependence on and consumption of fossil fuels a health issue?
Gerald Kierzek: I believe that whatever is good for the planet is good for your health. But the crisis of our health system is so strong that the main concern of the French – and various polls show it well – is health. It remains the priority, because the French want concrete measures, decision-making at their level, which affects their daily lives. We have to play together. When it comes to health, you can’t oppose the parties, it’s a partnership. This must be a partnership between manufacturers, patients and healthcare professionals. And the state must play its part in facilitating all these relationships.
What is your assessment of the health policy for old age, what does or should this declaration of intent mean?
Gerald Kierzek: For old age as for all ages, health is the most precious good and the only subject that concerns us from birth to death. What is the objective of our country: to save money above all or to treat properly? These last years, if not decades, have been marked by an objective of cost reduction and de facto of the quality and safety of care. The bottom line is that we have to change the model.
Let’s decide to age better, to take care of our elders with dignity (at home or in a retirement home when home is no longer possible), let’s reinvest! Proximity and humanity must guide the next decisions and the next measures taken for the health of all, of the oldest, of course, whose needs are great. We must also put humanity back into hospital services, maternity wards, retirement homes… And technologies must remain at the service of Man and not replace him. There is an urgent need to put people back at the heart of our society ; it requires vision and investments.