Background
In this episode Sean Scull from SKEMA Publika, welcomes two researchers from SKEMA Business School:
Benjamin Legros, Professor of Operations Management and author of the policy paper “The crisis in the French healthcare system: Solutions to relieve congestion in emergency departments”, which explores the optimisation of patient flows, real-time management and the redesign of the patient journey.
Benjamin Montmartin, Professor of Econometrics and Data Science at SKEMA Business School and Director of the Chair for Prevention and Access to Healthcare, author of the policy paper “The advantages of mandatory policies: Tackling medical deserts in France”, which analyses regional inequalities and examines the regulation of the establishment of private practitioners.
With contributions from:
– Jean Dellamonica, Dean of the Faculty of Medicine at Nice and Professor of Intensive Care and Resuscitation.
– Mathieu Raux, anaesthetist and intensive care specialist (Pitié-Salpêtrière Hospital)
– Thomas Botrel, Anaesthetist and Intensive Care Specialist (Pitié-Salpêtrière Hospital), Arts et Métiers graduate and PhD candidate in Public Health and Operations Management.
– Pierre-Alexis Gauci, Obstetrician and Gynaecologist (Nice University Hospital).
The multifaceted nature of the crisis in the French healthcare system
In this interview, the speakers discuss the overcrowding of emergency departments as one of the causes of the crisis in the French healthcare system. They explore how mathematical models can be used to optimise the management of queues in emergency departments, taking into account human and organisational factors. Furthermore, the panellists discuss the growing shortage of doctors as one of the root causes of difficulties in accessing healthcare for the French population. The discussion covers the organisation of private practice in France as well as the effectiveness of regulatory policies as well as incentive schemes to combat medical deserts.
Overcrowding in emergency departments and the challenges of patient flow, disorganisation and working conditions
One factor behind the overcrowding in emergency departments is thought to be linked to the issue of inappropriate patient flow. These departments face a problem of excessive patient numbers, with a significant proportion of people attending emergencies when their condition does not necessarily warrant it. This misdirection of patients directly contributes to the saturation of facilities, making the management of genuinely urgent cases more complex and thereby exacerbating the organisational difficulties encountered within the hospital system. Emergency department congestion is also thought to be linked to organisational shortcomings stemming from a lack of coordination in the care pathway. Emergency departments come under severe pressure when problems arise both upstream and downstream of the care pathway. Upstream, the difficulty in obtaining a medical consultation quickly drives some patients to turn to emergency departments, even when their situation does not constitute a genuine emergency. Downstream, when patients requiring hospitalisation cannot find an available bed quickly enough, care within Emergency departments becomes even more complicated.
Finally, the discussion also addresses the disorganisation in emergency departments, which is said to be due to poor working conditions for staff.
A link between private practice and overcrowding in Emergency departments
The interview also discusses the close link between private practice and hospital medicine. Indeed, a decline in the number of general practitioners leads to increased activity in emergency departments. Thus, when access to private practice deteriorates, part of the demand for care automatically shifts to the hospital. For a growing number of patients, emergency departments then become, not necessarily, the most appropriate place, but the place that is actually accessible. Consequently, the overcrowding of emergency departments cannot be analysed in isolation from the reduction in outpatient services.
Thus, the observation that a significant proportion of emergency admissions do not constitute life-threatening emergencies must be rephrased with precision: this is not merely a case of patients being “misdirected”, but also of a growing failure of general practice to absorb part of the demand for unscheduled care. This explains why a policy to relieve pressure on emergency departments cannot rely solely on the hospital itself: it also requires restoring effective capacity in general practice, particularly in areas where rapid access to a general practitioners or paediatrician has become most difficult.
Mandatory and regulated practice location for private practitioners
Public policies based on voluntary participation or regulated practice location are a sensitive topic. Despite the proliferation of incentive schemes over the past twenty years aimed at attracting private practitioners to underserved areas, regional inequalities in access to healthcare remain significant and, for many specialities, are worsening. The limited effectiveness of current measures is partly because they do not address the primary factors influencing the choice of practice location. This suggests that the freedom to choose where to practise should not be treated as an absolute principle of healthcare organisation, and that the regulation of where private practitioners may set up practice should be open to debate. Other private healthcare professions are already subject to more restrictive territorial agreement rules in oversupplied areas, notably dental surgeons and midwives.
The debate on the transfer of responsibilities
Another important avenue is the transfer of responsibilities between healthcare professionals. The aim is not to replace doctors with other professions, but to organise care more effectively by entrusting certain standardised procedures or follow-up care to trained professionals, within a safe and coordinated framework. This type of organisation could improve access to care, particularly in areas where medical resources are scarce, provided that the transfer of responsibilities is accompanied by clear protocols, appropriate training and genuine teamwork. In France, this approach is already gaining ground through cooperation protocols, advanced nursing practice and the expansion of the roles of pharmacists and midwives. The transfer of responsibilities is therefore not a miracle solution, but it appears to be a pragmatic lever for easing the pressure on doctors and improving access to care, particularly in the most vulnerable areas.
Chapters
3 min 20 – 5 min 09: Jean Dellamonica: Congestion in Emergency departments is one of the causes of the crisis in the French healthcare system.
5 min 23 – 6 min 48: Benjamin Legros: Emergency departments are facing an influx of patients who should not be there.
7min 06 – 9 min 25: Thomas Botrel: Hospital disorganisation has an impact on the quality of care.
9 min 26 – 10 min 55: Mathieu Raux: Acrual in Emergency departments jeopardises the functioning of the hospital.
10 min 56 – 12 min 27: Benjamin Legros’s ideas for relieving pressure on Emergency departments.
12 min 30 – 14 min 27: Mathieu Raux : one of the causes of Emergency departments congestion is poor working conditions for staff.
14 min 28 – 19 min 53: Benjamin Legros: To improve the functioning of Emergency departments, we need to make better use of existing resources.
19min 54 – 23min 27: Thomas Botrel’s pragmatic solutions for improving the flow in Emergency departments.
23min 28 – 26min 42: Benjamin Montmartin: there is a link between medical deserts and Emergency departments congestion.
26 min 42 – 30 min 30: Jean Dellamonica: To tackle hospital overcrowding, we need to redefine the role of General practitioners.
30 min 31 – 38 min 26: Benjamin Montmartin: Public policies on the establishment of General practitioners influence medical deserts.
38 min 28 – 44 min 00: Pierre-Alexis Gauci: To reduce medical deserts, we must move away from the binary logic of incentives versus coercion.
44 min 01 – 48 min 50: Benjamin Montmartin: Regulating the establishment of private practitioners is a sensitive but necessary debate.
48 min 51 – 52 min 08: Pierre-Alexis Gauci: An observatory should be set up to better map healthcare practitioners and their practices.
52 min 08 – 55 min 12: Jean Dellamonica and the impact of the reform of the numerus clausus.
55 min 14 – 58 min 01: Benjamin Legros’s three proposals for overcoming the crisis in the French healthcare system.
58 min 06 – 1 h 02 min 15 : Benjamin Montmartin’s three proposals for overcoming the crisis in the French healthcare system.
