In the midst of the Covid-19 epidemic and massive arrivals of patients in the emergency room, Emmanuel Macron wanted to show his support for hospital staff. With even a striking and stumbling recognition. This Wednesday, March 25, in Mulhouse, he announced “an exceptional bonus” for the caregivers involved, which will take the form of an increase in overtime. And that's not all. “The commitment I make this evening for them and for the whole nation, he continued, is that at the end of this crisis, a massive plan of investment and upgrading of the all quarries will be built for our hospital. “
If he keeps his word, it will indeed be a complete reversal of the budgetary policy carried out in hospitals in recent years. Since 2009, successive governments have indeed tightened the screws on health establishments by granting them increases in appropriations lower than the mechanical progression of health expenditure linked to the aging of the population. In fifteen years, the French Hospital Federation has calculated the efforts made at 8.6 billion euros. Under François Hollande, the envelope of hospitals had been cut by three billion in three years, including 860 million on the wage bill, the equivalent of 22,000 positions.
“Unintelligible effort at savings”
Since 2017, the Ministry of Health has posted a change of gear. He has communicated a lot about a “loosening” of the envelope of health expenditure – the National Objective of health insurance expenditure (Ondam), in the jargon -, but this increase was largely amputated by inflation which is started to rise again. Once the price increase has been deducted, hospital budgets have even lost around 1.5 billion euros between 2017 and 2020, compared to the Holland period. As early as June 2018, the Court of Auditors had also noted the circle by pointing out “a significant effort in a context of gradually rising inflation”. As for the French Hospital Federation, it denounced a few months ago “an incomprehensible savings effort” of 800 million expected in 2020, after months of strike in the emergency services.
In 2019, the government also boasted of having raised the rates of operations paid by the Safely to hospitals for the first time in ten years. In fact, if it was a real breath of fresh air, this increase was mainly enabled by the sudden slowdown in the volume of care provided in public health facilities in 2017 and 2018. The budgetary envelopes voted at the start of the year were even “under-executed” by 555 million euros in 2017, then by 325 million euros in 2018.
“The government only decided to increase tariffs at hospitals after seeing their activity drop and it waited two years before doing so,” deciphers a senior official in the Ministry of Health, who explains the fall. of activity by “the policy of wage rigor and the deterioration of the working conditions of the personnel which led to serious difficulties of recruitment and to services which are idling”. In October, the Public Assistance-Hospitals of Paris had also recognized that 900 hospital beds were closed for lack of staff. And private clinics have not seen a drop in activity.
Average hospital salary down in 2018
In fact, the budgetary restrictions at the hospital have a direct impact on the personnel since the wage bill represents between 60 and 85% of the budget of health establishments. In an article in The Health Tribunes, the economist Pierre-Louis Bras shows that the rigor imposed on hospitals since 2009 has led to a deterioration in the purchasing power of hospital staff compared to private sector employees. And that, at the same time, the pace of work has accelerated since between 2010 and 2017 the volume of care increased by almost 15% in hospitals for an increase in staff of barely 2% … average net salary in the hospital public service even decreased by 1% in 2018 after deduction of inflation, according to the latest data from INSEE.
Until the announcement on March 25 of Emmanuel Macron, the government was still counting on a further freezing of the index point, on the basis of the calculation of civil servants' salaries, until 2022 and a stabilization of hospital staff. “It may be necessary to achieve public finance objectives, wrote Pierre-Louis Bras in early 2019, but it is unlikely that public hospitals and the quality of care can, without damage, support it.” But that was before the coronavirus crisis. In other words, centuries ago.