Public hospitals in France are facing an unprecedented crisis. The coronavirus pandemic has shed light on the long-standing weaknesses of public health institutions nationwide. After years of debt and deteriorating working conditions, the future of French hospitals has never been so uncertain. In 2020, the French hospital landscape comprised 1,347 public hospitals, 670 private non-profit establishments, and 972 private clinics. However, over the last twenty years, the
shrank by thousands yearly. This decline can be explained by the significant increase in
(without overnight stay) and staff constraints that do not allow the beds to be maintained.
Public hospitals face an unprecedented shortage of human resources.
The public hospital sector struggles to recruit in a society increasingly attentive to work-life balance, individual recognition, and working conditions. As a result, many positions are vacant in hospitals. For example, nurses and nursing assistants were France's two
professions with the highest vacancies in 2022. That year,
vacancy rates among physicians in public hospitals stood around 30 percent yet reached even higher rates among certain specialties. French emergency services are also struggling due to a need for more human resources. Since December 2021, over 30 thousand
patients have been left on stretchers at night due to the country's lack of emergency services (ER) beds.
Hospitals are different from other businesses. Their profitability comes with a cost.
Over the past 30 years, the public hospital has gradually shifted into an era of profitability. To reduce expenditure, successive governments have launched ever more restrictive measures such as the program for the medicalization of information systems (PMSI), the national objective for health insurance expenditure (ONDAM), or activity-based pricing (T2A). For twenty years, the ONDAM has allocated budgets to public hospitals that are systematically lower than the actual needs to "optimize expenditure". The
growth rate of wages testifies to how remuneration has stagnated for years in the public hospital sector and has only recently increased due to covid packages. In 2020, after seven years of deficit, the financial accounts of public hospitals in France returned to near balance. Nonetheless, the
share of excessive debt among public hospitals reveals that nearly a third of public hospitals in France remain overly indebted. As a result, hospitals face increasing
rates of equipment dilapidation and
building decay rates. Therefore, investing massively in public hospitals is vital to reduce costs and guarantee the best possible level of performance and safety in the future.
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