“The emergency is not the debt, it's the avoidable deaths”: emergency physician Christophe Prudhomme at a conference-debate in Mende

Christophe Prudhomme, médecin urgentiste à l’hôpital Avicenne de Bobigny (Seine-Saint-Denis). – DR

The regional councilor La France insoumise (LFI) of Île-de-France, spokesperson for the Association of Emergency Physicians of France, also a member of the board of the National Health Insurance Fund for the CGT, will hold a conference-debate, this Saturday, January 18, 2025, at 2 p.m., at the Mende events space. The state of the French health system will be discussed. Interview.

You will be, this Saturday, January 18, 2025, in Mende, to talk about the emergency system in France ?

To talk about the health system in general. The emergency room is the magnifying glass of all the dysfunctions. The government's response is always to stigmatize this person or that person. If the emergency room is overcrowded, it's because people are supposedly coming for nothing. If we have the flu, it's because people aren't getting vaccinated. No. The problem is that today we have a health system that is dramatically lacking in resources.

What message do you want to convey?

The message we want to get across is that the emergency is not the debt we are going to leave to our children, it is the avoidable deaths that we need to worry about right now, whether in the emergency room, whether it is newborns due to a lack of neonatal intensive care beds, or due to a lack of maternity wards…

And where to find the money?

If we taxed dividends at 20% – not profits, but only dividends – paid by CAC 40 companies – so it is not confiscatory – we would have 20 billion euros. They paid out 100 billion in 2024. That increased by almost 9% last year. With this money, we would no longer have deficit problems, lack of resources for health insurance. We would no longer have problems with pensions.

There is an element in the preamble to the Constitution that Emmanuel Macron, the President of the Republic, and his predecessors forgot. Health is a public service. The State must ensure equal treatment of all citizens with regard to public service, regardless of their place of residence in the territory. Currently, when you live in Lozère or Seine-Saint-Denis, this constitutional principle is not respected.

We continue to have liberal medicine with people who settle where they want, when they want. We have specialist doctors who consider that they are not paid enough by the Social Security and who charge excess fees. This leads to some patients giving up care. In a department like Lozère, with an aging population, there must be local services. It is very difficult to go and get treatment hundreds of kilometres away, because we have not organised a healthcare offer in the territory.

Precisely, how do you judge the healthcare provision in Lozère ?

Even if the Mende hospital remains a reference hospital, it has difficulties operating. We especially have a problem concerning community medicine. Given the system, the freedom of establishment and the method of remuneration, doctors are setting up in the metropolises. They no longer want to set up in the suburbs and in areas of low population density.

What solution do you advocate ?

We want to make a bill on regulating the establishment of doctors. That is not the problem. The question is how we organize the health system in the territories. There is not the hospital on one side and city medicine on the other. For the latter, there must be no more freedom of establishment and, above all, no more payment per act. Doctors work in what are called health centers. They are employees there. That does not mean that we nationalize the system. We are also proposing that these health centers be managed in a cooperative form by the professionals themselves. On the other hand, it is the structure that is paid, it is no longer the practitioner who is paid per consultation. Above all, they have public health objectives that correspond to the reality of their territory.

That is to say ?

Managing the health of the population in Marvejols is not the same as managing the health of the population in Nice (Alpes-Maritimes). There must be contractual objectives and remuneration that will allow doctors in Marvejols to have fewer procedures. Visiting patients at home, when you have to travel miles and miles each time, is not the same as being in an urban area, in Nice, where your patients are in a limited perimeter. So you cannot have the same method of remuneration when you are in Lozère and when you are in Boulogne-Billancourt (Hauts-de-Seine). And even between Boulogne or Saint-Ouen (Seine-Saint-Denis). Explaining diabetes to someone with a BAC + 5 education level is not the same as when you have a worker of immigrant origin who has a poor command of French, who has difficulty reading. On the other hand, both have the right to education to be able to properly manage their pathology. So it can no longer be €30 for a ten-minute consultation.

Does this mean the end of excess fees ?

Yes, a salaried doctor no longer charges excess fees. On the other hand, salaried employment does not mean “everyone at the same level”. The doctor who agrees to set up in Lozère, in an area with a low population density, must have working conditions and a salary higher than those of a practitioner who, for his part, is peacefully practicing in his office in the 8th arrondissement of Paris.

You are proposing a real paradigm shift…

The question is whether we should continue with a system that is becoming financialized. We have private operators who buy medical biology laboratories and clinics, who invest in nursing homes, in daycare centers… We see what this leads to with the Orpea and People & Baby scandals. It is a drift that will lead us to a very unequal American-style system.

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