{"id":32131,"date":"2017-02-01T17:08:17","date_gmt":"2017-02-01T16:08:17","guid":{"rendered":"https:\/\/gestions-hospitalieres.fr\/?p=32131"},"modified":"2018-03-06T13:43:40","modified_gmt":"2018-03-06T12:43:40","slug":"vive-lhospitalo-centrisme%e2%80%89","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/vive-lhospitalo-centrisme%e2%80%89\/","title":{"rendered":"Vive l\u2019hospitalo-centrisme\u2009!"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 3<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><p>L\u2019h\u00f4pital, par sa trop grande place, aurait atrophi\u00e9 la m\u00e9decine lib\u00e9rale\u2009; il co\u00fbte, rengaine connue, cher, est trop peu efficace, trop centr\u00e9 sur lui-m\u00eame.\u00a0Pis, si l\u2019on en croit un d\u00e9put\u00e9 auteur, en 2016, d\u2019une proposition de loi pr\u00e9sent\u00e9e comme un programme de sant\u00e9 se voulant l\u2019antith\u00e8se de la loi Sant\u00e9 de janvier 2016, l\u2019h\u00f4pital \u00ab\u2009<i>ne permet pas de r\u00e9pondre \u00e0 l\u2019ensemble des besoins de la population<\/i>\u2009\u00bb. Et l\u2019un de ses coll\u00e8gues de rench\u00e9rir\u2009: \u00ab\u00a0<i>Nous devons, en effet, sortir de l\u2019hospitalo-centrisme ; nous, nous souhaitons une politique de sant\u00e9 \u00e9quitable sur l\u2019ensemble du territoire, dans laquelle le priv\u00e9 et le public ont leur place.<\/i><sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(1)<\/sup>\u2009\u00bb Voici donc une accusation suppl\u00e9mentaire, ainsi qu\u2019une tentative de d\u00e9finition\u2009: l\u2019hospitalo-centrisme, c\u2019est avant tout la trop grande part des h\u00f4pitaux publics dans le syst\u00e8me de soins, au d\u00e9triment de la m\u00e9decine de ville et des h\u00f4pitaux priv\u00e9s.<\/p>\n<p>Il est regrettable, toutefois, que ce reproche ne s\u2019appuie sur aucune donn\u00e9e pr\u00e9cise\u2009: l\u2019on en reste trop souvent aux grands discours et aux p\u00e9titions de principe. Ce qui est fort dommage.\u00a0Car avant de d\u00e9plorer le trop grand poids des h\u00f4pitaux, pourquoi ne pas regarder si ce reproche est aujourd\u2019hui justifi\u00e9\u2009? Que l\u2019on prenne, par exemple, la loi de financement de la s\u00e9curit\u00e9 sociale (LFSS) pour 2017\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(2)<\/sup>, et la d\u00e9composition de l\u2019Objectif national des d\u00e9penses d\u2019assurance maladie (Ondam)\u2009: il s\u2019\u00e9tablit pour cette ann\u00e9e \u00e0 190,7\u00a0milliards d\u2019euros. Or le sous-objectif consacr\u00e9 aux soins de ville s\u2019\u00e9l\u00e8ve \u00e0 86,6\u00a0milliards d\u2019euros, et celui consacr\u00e9 aux \u00e9tablissements de sant\u00e9 (publics et priv\u00e9s), \u00e0 79,2\u00a0milliards d\u2019euros. M\u00eame si l\u2019on y ajoute le fonds d\u2019intervention r\u00e9gional (Fir), dont une partie seulement est destin\u00e9e aux \u00e9tablissements de sant\u00e9, on n\u2019arrive qu\u2019\u00e0 82,3 \u00a0milliards d\u2019euros, soit 4\u00a0milliards de moins que les soins de ville\u2009<sup class=\"appel\" data-toggle=\"modal\" data-target=\"#notes\">(3)<\/sup>. Il convient donc, pour le moins, de relativiser le pr\u00e9tendu hospitalo-centrisme.<\/p>\n<p>N\u2019oublions pas non plus que les h\u00f4pitaux ne sont pas que des acteurs de sant\u00e9\u2009: ils participent pleinement \u00e0 l\u2019am\u00e9nagement du territoire. Qui peut, s\u00e9rieusement, sans crainte du ridicule, pr\u00e9tendre que s\u2019il y a de moins en moins de m\u00e9decins lib\u00e9raux, c\u2019est la faute des h\u00f4pitaux\u2009? Est-ce la pr\u00e9sence d\u2019un h\u00f4pital, ou le manque d\u2019attractivit\u00e9, qui dissuade un m\u00e9decin de s\u2019installer en r\u00e9gion rurale ou semi-rurale, ou dans une zone d\u00e9favoris\u00e9e, ou peu dynamique, avec des services publics de moins en moins nombreux\u2009? Faut-il bl\u00e2mer les h\u00f4pitaux si leurs urgences sont ouvertes en continu, et prennent en charge les patients gratuitement, \u00e9l\u00e9ment \u00f4 combien important pour une partie de la population, pour qui une visite chez le m\u00e9decin, m\u00eame en partie rembours\u00e9e, repr\u00e9sente une d\u00e9pense qu\u2019il devient difficile d\u2019assumer\u2009? Les h\u00f4pitaux, et tout particuli\u00e8rement les ex-h\u00f4pitaux locaux, assurent un maillage territorial consid\u00e9rable, et repr\u00e9sentent souvent l\u2019un des derniers services publics dans de nombreux territoires. Bien loin de venir concurrencer l\u2019offre de ville, ou de l\u2019emp\u00eacher, ils pallient son absence.<\/p>\n<blockquote><p>Malgr\u00e9 toutes ses imperfections, l\u2019hospitalo-centrisme est aujourd\u2019hui la meilleure garantie de la prise en charge et de la continuit\u00e9 des soins, sinon sur tout le territoire, du moins sur sa majeure partie.<\/p><\/blockquote>\n<p>Une \u00e9tude publi\u00e9e par les six CHR-CHU du Grand-Ouest<sup>\u2009(4) <\/sup>et la chambre de commerce et d\u2019industrie de Nantes et Saint-Nazaire sur l\u2019impact \u00e9conomique des h\u00f4pitaux publics<sup>\u2009(5)<\/sup> met en avant, entre autres, les \u00e9l\u00e9ments suivants\u2009: les six CHU ayant particip\u00e9 \u00e0 l\u2019\u00e9tude emploient plus de 50\u2009000\u00a0personnes\u2009; avec 1,24\u2009% des emplois du Grand Ouest, ces six \u00e9tablissements sont, de loin, les premiers employeurs du territoire. Autre fait notable\u2009: cette m\u00eame ann\u00e9e, ils ont re\u00e7u 1,25\u00a0million de patients diff\u00e9rents. Ils ont d\u00e9pens\u00e9, en 2014, 3,4\u00a0milliards d\u2019euros, dont 2,4 directement dans le Grand Ouest. En termes financiers, leur impact \u00e9conomique global p\u00e8se environ deux fois plus que leurs d\u00e9penses de fonctionnement. Autrement dit, chaque euro d\u00e9pens\u00e9 directement par les CHU, entra\u00eene le reversement de 2\u2009\u20ac dans l\u2019\u00e9conomie du Grand Ouest. En ces temps o\u00f9 l\u2019on parle de relance, les h\u00f4pitaux publics sont ainsi un excellent exemple d\u2019effet multiplicateur keyn\u00e9sien\u2009! Et, avant de critiquer l\u2019hospitalo-centrisme, il serait appr\u00e9ciable de demander quelle autre d\u00e9pense, aujourd\u2019hui en France, garantit un tel effet multiplicateur.\u00a0Il ne s\u2019agit pas, bien s\u00fbr, d\u2019opposer \u00e0 une critique \u00e0 courte vue de l\u2019hospitalo-centrisme un pan\u00e9gyrique b\u00e9at. Les h\u00f4pitaux, au premier rang desquels les h\u00f4pitaux publics, doivent non pas tant faire des efforts, car ils en font d\u00e9j\u00e0, et souvent immenses, que poursuivre dans des voies connues\u2009: pr\u00e9vention, coop\u00e9ration entre \u00e9tablissements, y compris priv\u00e9s, ouverture sur la ville, alternatives \u00e0 l\u2019hospitalisation, m\u00e9decine et chirurgie ambulatoires, fili\u00e8res coordonn\u00e9es, et ainsi de suite. La liste est longue. Le d\u00e9fi qui attend les h\u00f4pitaux est tout aussi grand que les efforts qu\u2019ils ont d\u00e9j\u00e0 faits, et qu\u2019ils continuent de faire.<\/p>\n<p>Mais plut\u00f4t que de leur reprocher leur trop grand poids, pourquoi ne pas reconna\u00eetre les h\u00f4pitaux pour ce qu\u2019ils sont\u2009: l\u2019acteur indispensable de la prise en charge sanitaire, un acteur \u00e9conomique de premier plan, et un \u00e9l\u00e9ment majeur de l\u2019organisation sociale et territoriale\u2009? Plut\u00f4t que de critiquer sans cesse le trop grand poids des h\u00f4pitaux, au nom d\u2019un concept qui arrange d\u2019autant mieux qu\u2019on ne prend pas la peine de le d\u00e9finir ni de le justifier, pourquoi ne pas inverser le discours\u2009? L\u2019hospitalo-centrisme, malgr\u00e9 toutes ses imperfections, est aujourd\u2019hui la meilleure garantie de la prise en charge et de la continuit\u00e9 des soins, sinon sur tout le territoire, du moins sur sa majeure partie. Alors, apr\u00e8s tout, tant qu\u2019on n\u2019aura pas mieux que des discours \u00e0 proposer, vive l\u2019hospitalo-centrisme\u2009!<\/p>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 3<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span>L\u2019h\u00f4pital, par sa trop grande place, aurait atrophi\u00e9 la m\u00e9decine lib\u00e9rale\u2009; il co\u00fbte, rengaine connue, cher, est trop peu efficace, trop centr\u00e9 sur lui-m\u00eame.\u00a0Pis, si l\u2019on en croit un d\u00e9put\u00e9 auteur, en 2016, d\u2019une proposition de loi pr\u00e9sent\u00e9e comme un programme de sant\u00e9 se voulant l\u2019antith\u00e8se de la loi Sant\u00e9 de janvier 2016, l\u2019h\u00f4pital \u00ab\u2009ne permet pas de r\u00e9pondre \u00e0 l\u2019ensemble des besoins de la population\u2009\u00bb. Et l\u2019un de ses&hellip; <\/p>\n","protected":false},"author":23133,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[2,72],"tags":[5128,5127,1992,5129],"class_list":["post-32131","post","type-post","status-publish","format-standard","hentry","category-gestions-hospitalieres","category-reflexion","tag-grand-ouest","tag-hospitalo-centrisme","tag-loi-sante","tag-maillage-territorial"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Vive l\u2019hospitalo-centrisme\u2009! - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/vive-lhospitalo-centrisme\u2009\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Vive l\u2019hospitalo-centrisme\u2009! - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Temps de lecture\u00a0:  3 minutesL\u2019h\u00f4pital, par sa trop grande place, aurait atrophi\u00e9 la m\u00e9decine lib\u00e9rale\u2009; il co\u00fbte, rengaine connue, cher, est trop peu efficace, trop centr\u00e9 sur lui-m\u00eame.\u00a0Pis, si l\u2019on en croit un d\u00e9put\u00e9 auteur, en 2016, d\u2019une proposition de loi pr\u00e9sent\u00e9e comme un programme de sant\u00e9 se voulant l\u2019antith\u00e8se de la loi Sant\u00e9 de janvier 2016, l\u2019h\u00f4pital \u00ab\u2009ne permet pas de r\u00e9pondre \u00e0 l\u2019ensemble des besoins de la population\u2009\u00bb. 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