Health: hospital, medical deserts… the programs of Emmanuel Macron and Marine Le Pen

Emmanuel Macron or Marine Le Pen? Who will be able to better treat the French health system, whose wounds have been exacerbated by the Covid-19 pandemic? So far, the outgoing president has praised the health report for his first five years, more than detailing his program for a second term: 100% health reform, free contraception for those under 26, deployment of health centers, elimination of the clausus number in the medical school or even revaluation of caregivers within the framework of the Ségur de la santé. On the contrary, the candidate of the National Association (RN) dedicates a dossier of twenty pages to the recovery of the French health system.

However, in the main lines of their programs, we detect almost the same objectives. The two candidates for the Elysée Palace have their sights set on rescuing the public hospital, the fight against medical deserts, but also on improving prevention. But everyone has their own method. Summary of the main measures of Emmanuel Macron and Marine Le Pen to improve the health of the French.

Humanize the public hospital

As for the hospital, Emmanuel Macron wants to make it “more humane” by reducing the administrative burden on caregivers and giving more responsibilities to paramedics such as nurses, caregivers or pharmacists. Without giving too many details, the outgoing president also wants to modify the governance of hospitals to grant “a central place” to doctors.

The same course for Marine Le Pen, who, however, has much more detailed the implementation of her program to further humanize hospitals. In the first place, she intends to suppress the regional health agencies (ARS) to entrust the supervision of the establishments to the regional prefects, through the General Directorate of Health and Social Affairs. The ARSs are now responsible for implementing the government’s health policy at the regional level. They coordinate activities and distribute the budget, as necessary, to all hospital structures in the region.

The far-right candidate’s program is also more specific in terms of hospital governance reform. This would become bicephalous, that is, shared between the director of the hospital for administrative aspects and a doctor in charge of medical affairs. Finally, unlike Emmanuel Macron who did not specify how he intends to debureaucratize health establishments, Marine Le Pen announces the color by setting a ceiling of 10% of administrative positions in hospitals. What “creates room for maneuver to hire more nursing staff”, she specifies in her program.

recruit caregivers

It is still necessary to have enough trained caregivers to rescue hospital services. In her program, Marine Le Pen plans to open “a sufficient number of places” in medical universities, and at the same time “drastically reduce the use of doctors who have obtained their diploma outside the European Union.” The fact is that the abolition of the numerus clausus, which occurred during the five-year period of Emmanuel Macron, and the gradual increase in places in the faculties will only cover the needs in the medium or even long term.

Thus, the candidate of the National Rally plans to “recruit en masse to fill vacancies” and open 10,000 additional places in nursing training institutes and nursing assistant training centers. assistants, health professionals who are needed to keep hospital beds open. In this sense, Marine Le Pen intends to create a moratorium on the closure of beds.

It remains to restore the image of the medical and paramedical professions whose structural difficulties and exacerbated by the health crisis have led several caregivers to throw away their white coats. Marine Le Pen then activates the financial lever to attract them by promising them 2,000 million euros in 5 years to increase the salaries of hospital staff. The far-right candidate intends, for example, to increase the salary of nurses by 10% to reach the European average.

Eradicate medical deserts

In addition, enhancing the attractiveness of the medical and paramedical professions would indirectly contribute to reducing medical deserts. Undoubtedly the health issue most mentioned by presidential candidates. And the two candidates selected for the second round do not plan, unlike Yannick Jadot or Fabien Roussel, to bet on the constriction of the installation of doctors in these disadvantaged areas.

Instead, they prefer to activate incentive levers. Such as the remuneration of the general medicine consultation, which Marine Le Pen wishes to modulate according to the place of installation, “without the doctors having to take specific steps”. Clearly, a doctor who chooses to practice in an area of ​​scarce resources should be paid more than a colleague based in a territory that is not in tension.

For his part, Emmanuel Macron is thinking of better remunerating the first consultation of a doctor who becomes a patient’s GP. “No surplus for the patient,” says one of his campaign team. According to the National Health Insurance Fund (Cnam), 6.3 million French people do not have a doctor. This issue should be discussed during a “stakeholder conference”. A kind of special health “grand debate” that the outgoing president intends to organize from the beginning of his five-year term with doctors, citizens and local elected officials, if he is re-elected. To free up medical time for doctors, he wants to keep hiring physician assistants. Nearly 3,000 contracts have already been signed, according to Cnam. The use of telemedicine, in particular teleconsultations, is also a solution proposed by the two candidates to facilitate access to care in territories with a shortage of doctors.

Delegate more to paramedics

Still with a view to fighting against medical deserts, Emmanuel Macron wants to transfer tasks to pharmacists and nurses who could become territorial references. A title that allows them to guarantee more acts of prescription, such as treatment renewals. Which, logically, would again free up time for general practitioners to monitor other patients. Même idée pour Marine Le Pen, qui veut accroître le temps Médical du médecin en elargissant la list des tâches confiées aux pharmaciens, aux sages-femmes, aux infirmiers et aux assistantes sociales, “par exemple pour la détection de la perte d’autonomie des old people”.

unblock emergencies

The two candidates competing for the Elysee also want to unblock emergencies through better cooperation between the city’s medicine and the hospital. Thus, Emmanuel Macron trusts in the occasional stay in territories with scarce resources. He also points to a better articulation between the medicine of the city and the hospital. What he and his campaign team used to call “extramural hospital.” The idea is to facilitate the use of the mixed exercise, very popular among young doctors. That is, a general practitioner can provide consultation in the city in a practice while employed by the hospital.

For her part, Marine Le Pen intends to increase the number of homes and health centers “to cover the needs of the population as much as possible”. Created by the Social Security financing law of 2008, these infrastructures are developing very slowly in France. As of December 31, 2021, according to the government, the country had a total of 2,018 nursing homes (984 more than in 2017). These structures must, according to the RN candidate, be capable of treating “minor emergencies”, such as minor fractures. In addition to the deployment of these multiprofessional health establishments, Marine Le Pen intends to create a partnership between emergency services and private medical practices to which patients who go to city medicine and not to emergencies could be redirected.

To better regulate emergency services, the National Grouping candidate also plans to “create a specific sector for the elderly.” This should make it possible to shorten waiting times, improve care and guide older patients as best as possible. Either to a hospital service, either to a return address or to a specialized establishment.

old age

The health of the elderly is, in fact, one of the main concerns of the two candidates who are still in the race for the Elysee. Emmanuel Macron plans to hire an additional 50,000 nurses and caregivers in accommodation facilities for dependent elderly people (Ehpad) by 2027. That is 25% more than today, according to his program. Marine Le Pen also wants to increase the presence of medical personnel in these establishments. The RN candidate aims for a coordinating physician and nurse present 24 hours a day for each nursing home.

In addition to better medical supervision in the establishment, Emmanuel Macron also intends to launch a home care service with a single contact for the caregiver or the elderly person, with the aim of organizing all services. A “Premium Adapt” could see the light of day depending on the resources: then up to 70% of the costs of the adaptation work (bathroom, stairs, etc.) could be covered.

Prevention

The last major component of Emmanuel Macron’s health program, prevention. On the subject, the outgoing president goes further than his opponent Marine Le Pen, who dedicates a single line of her program to him, by wanting to systematize medical visits in schools. His re-election candidate first aims at better medical follow-up over time by creating a complete and free health check-up at 25, 45 and 60 years of age. He wants to improve support for patients suffering from a chronic disease like diabetes through remote monitoring. The goal is to rely on digital technology to, for example, monitor blood glucose in a personalized and connected way. If he is re-elected, Emmanuel Macron wants every child to have a doctor. Essential, according to him, to improve early detection of developmental deviations (hyperactivity, dyslexia, obesity, etc.). Screening and prevention plans related to mental health, infertility or even sickle cell disease could also be implemented over the next five years.

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