Medical Device Daily
PARIS — A hospital reform law now in the French Senate that would removes surgeons from decision-making in French hospitals has sparked strong opposition and for the first time sent heads of prestigious medical centers into the streets in protest.
In a city where street demonstrations are as common as traffic jams, the sight of world leading physicians marching and chanting with nurses and unionized caregivers was not just unusual, it was a first.
At stake in the reform law Hospital, Patient, Health and Regions (HPST) that the French Senate will begin debating in mid-May is the power to decide which medical equipment to purchase, capital investments in the construction of new surgical centers and annual budgeting that determines the specialties and orientation for hundreds of hospital centers across all regions of France.
The law drafted by the Health Ministry was put on a new legislative fast-track and approved by French Assembly in March.
With a majority in both houses, President Nicolas Sarkozy has every chance of pushing through the main points of HPST that would give new decision-making powers to a newly empowered CEO, or super-Boss, for public hospitals that will in turn serve as the hub for re-engineered regional healthcare clusters.
"No human endeavor can function without a leader," said Sarkozy, "I call it a 'boss.' I realize I am taking a risk saying that."
The law also spells out a series of rules and incentives for new Regional Health Authorities (ARS) to encourage general practitioners and specialists to move back into rural regions that are currently underserved.
To defuse opposition, the government separated these measures for restructuring France's healthcare administration from financing measures that are addressed in the Social Security Financing Law (LFSS 2010) and for capital investment in the plan, Hôpital 2012.
Yet HPST is charged with enough controversial proposals to have provoked widespread opposition from medical professionals who say they are being pushed out of decision-making, from regional authorities who see their powers being undermined, and from unions of nurses and caregivers who are threatened by the spirit of a law calling for a public hospital to be run like a private business.
"Do not fear reform," said Sarkozy, adding, "Who would tell me to keep the status quo for hospitals? No one."
Seizing upon an uproar among medical professionals, the Senate intends to modify the text, saying 'Non' to giving CEO status to hospital directors, and 'Yes' to returning doctors to hospital governance, according to former Prime Minister Jean-Pierre Raffarin, who is a leading member in the party of Sarkozy, the Union for a Presidential Majority.
In a televised interview, Raffarin clearly was enjoying the new powers of the French Senate, in which he played a key role winning in 2008, as he criticized the text approved by the Assembly as "too complex and not quite clear."
"We are not here to lie down to any text sent over from the Assembly," he said. "This is not a revolution, but it is showing something of a rebellious spirit," he said.
Despite its fast-track status, a prolonged stay in the Assembly and a detailed study ahead of debate in the Senate has given physicians an opportunity to gather their strength.
Angry that their counterproposals were not taken into consideration, the heads of the medical committees for France's leading hospitals in a press conference greeted the passage of the Bachelot law by the Assembly with a threat to quit their posts and suspend participation in hospital planning.
"Contrary to what is being said, the law is not going to expand the role of doctors in the operations of the hospital," said Alain Dest e, a neurologist with the Centre Hopitali re Universitaire (CHU) de Lille and president of the Conference of Presidents of the Medical Committees (CME; commission m dicale d' tablissement) for the CHUs.
Given a weak role in the selection of the super CEO, the CME presidents protest that they will be absent from planning objectives and budget with the head of the regional authorities, as well as cut out of internal contracting discussions that are vital to "spell out and sustain the medical orientation" of the hospital.
The CME opposition was followed by another hostile reaction from 25 prominent physicians affiliated with French university hospitals,who jointly published a position papers asking the Senate to completely revise the text approved by the Assembly, and then joined the planned street demonstration on April 28.
At the same moment, the association of French hospital directors wrote to Sarkozy, sending the letter to the French press as well, asking him to resist such changes that would "empty all sense" in the reform law.
The hospital directors said in their letter that any change in the HPST text that limits their ability to be the ultimate decision-maker by forcing co-decisions or the imposition of doctors opinions on any final decision would only lead back to the current state of affairs and thwart the ability of the super-CEO proposed in the Bachelot law to wrestle with the budget deficit.
Meanwhile, the French Hospital Federation (FHF) has fallen into line with the government, with Executive Director G rard Vincent saying, "There needs to be an orchestra leader, someone who can make decisions, and that is what is missing today."
Vincent said FHF favors this spirit in the reform law and supports the creation of regional health authorities, saying the challenge today is to "free up the energies in the departments so that a real wind of change will bring change to the current range of healthcare services and respond to the expectations of both medical professionals and patients."
Guillaume Sublet, head of economic intelligence and regulatory affairs with Nextep Consulting & Health Economics (Paris), predicts that despite the rebellious bravado of former Prime Minister Raffarin, the French Senate will ultimately have to vote with Sarkozy's position in mind.
"The president was very clear," said Sublet, who manages an online forum of interviews with leading players in the debate over the hospital reform.
"Medical practitioners may win some points about their importance," he said, "but we can expect that just as in the National Assembly, the core text will pass without significant modification and French hospitals will walk the president's line with a hospital chief executive leading a management inspired by the private enterprise model."