Public-private health services

I’ve great reason to be very grateful for the French health services and – cross fingers – will continue to benefit (until such a time as Brexit might take away my rights to use the system!). But although it justifiably has a high reputation internationally, there are worrying signs of cracks in the system, especially in rural areas.

There are not enough GPs and supporting services such as physiotherapists for what is an ageing population.  The local hospital in le Vigan  appears to have a secure future, but more as a place of first instance for mainly elderly patients and as a rather poor substitute for a hospice. I have heard that the ‘réeducation’ services from which I benefited in 2015 (nearly three months recuperating from a hip replacement and graft in 2015) are more at risk, with the tendency to send people to bigger centres in the big towns.

More alarming is last winter’s news (which I have only just learnt of) that the Clinic in Ganges and Les Chataigniers, the small local convalescent home, have been bought by a private health group called Cap Santé.

I still struggle to understand the complex structure of the French health system, but basically there are state run hospitals (‘hopitaux’) and privately run clinics (cliniques) which mainly work for the national health service. Most of the costs of a stay in hospital are covered by the state health system, but part of the cost of board and lodging are charged to the patient – who in turn gets all or most of it back from their complementary health insurance scheme (depending on what contract they have made). The clinic board and lodging charges can be higher than those of the hospitals and it depends on your mutuelle how much is covered. (I have quite a good insurance and have spent months in cliniques without paying anything – apart from the monthly insurance payments.)

But what I am learning is that there are cliniques and cliniques.  The Clinique at Ganges is a small but good hospital serving a huge population in the rural hinterland (I had my 2001 hip op there and the 2015 biopsy op to establish I did indeed have cancer, and have made frequent use of the radiography and outpatient services).

Until this recent take-over, this was a clinique mutualiste: that is, a clinique owned and run by one or several mutuelles (the complementary health insurance associations).  Unlike private cliniques these are non-profit making. For example, the surgeons in the mutualiste clinique in Montpellier where I was operated on last year were salaried and were not permitted to demand a fee higher than that which is covered by the national health system. This is in contrast to the two private cliniques where I had my shoulder and hip replacements.  The shoulder surgeon in particular extracted a somewhat gross supplementary fee (dépassement des heures supplémentaires) – he worked at the Clinique St Jean, which is in the group which has just taken over the Ganges clinic.

So what does it mean for the Clinique de Ganges to pass from mutualiste to private?  The Cap Santé has said that it is going to put considerable sums into the clinique, both to improve the existing establishment and to eventually built a new hospital in another location.  How can it do this and deal with the debts which the current clinique currently has?  The group claims that it aims to retain the mutualiste values… I fear there will be ‘efficiency’ savings and I cannot see how charges will not go up or services be cut back.

The group has also bought Les Chataigniers whose role as a convalescence centre for patients from Ganges is seen as complementary.  It claims it is going to invest 2m euros in modernising  les Chataigniers.  The only good thing I have read is that the improvements include building an on-site kitchen. Meals are currently delivered from Montpellier and I can vouch that they are disgusting!

I am of course by  political inclination uneasy about public-private partnerships.  The head of Cap Santé has said: “Je considère que les cliniques sont des entreprises comme les autres mais avec une grande responsabilité qui implique une véritable éthique et une vraie morale vis-à-vis des patients dont nous avons la responsabilité”.  That is, clinics are businesses but with an ethical and moral responsibility to patients.  He has also said there will be no redundancies. Huh, we will see.



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