Question 13023 — health

Summary

Ms. Gabrielle Cathala alerts the Minister of Health, Families, Autonomy and People with Disabilities to the massive liquidation of participatory and coordinated care structures, by deliberate choice of the Government. The trap is closing: since 2021, the Government has engaged 26 health centers and homes in priority neighborhoods in an experiment, called SECPa (structures for coordinated participatory exercise). Following the crisis of covid-19, several ministerial services had noted the collapse of health care in working-class neighborhoods and rural areas, due to lack of continuity and close network of the medico-social offer. They therefore canvassed the most innovative health structures, which had shone at the time of the crisis: those which adopt the “participatory” form of access to care, which grants users a role in the organization of services. health care and recognizes their power of decision and autonomy. Under article 51 of the social security financing law for 2018, a legislative measure which governs full-scale tests with a given population, a fund of 14 million euros had been dedicated to such structures, or a third of their overall budget. This financing thus supplemented the fee-for-service pricing, which is totally inadequate for such democratic and progressive experiments, the results of which the Government recognized. It was conditional on nine criteria: proximity exercise, reception adapted to vulnerable people, psychological support, health mediation, training in the participatory approach, implementation of the participatory approach, professional interpreting, prevention and health education. These specific funds were dedicated to so-called “non-care” envelopes, which recognize the decisive contribution of reception staff, interpreters or health mediators in the same way as doctors or nurses to ensure the health of individuals (taking into account access to housing, family problems, psychological disorders, etc. in combination with infections or bodily pain). They also financed “participatory” actions, which bring together patients around prevention, awareness or pain management workshops. Participatory workshops and non-care envelopes marked a break with the positivist dynamic of fee-for-service pricing and a recognition of the voice and feelings of patients in the construction of a public health system and the fight against inequalities. They position structures at the heart of their ecosystem, link with organizations or associations fighting against addictions, against discrimination, for access to education and culture... We come across collectives fighting against sexual and gender-based violence as well as mediators vis-à-vis social landlords. Because social inequality always underlies health inequality. The 26 structures selected in the SECPa experiment are distributed throughout France: Paris (MSP Pyrénées Belleville and Mathagon), in Toulouse (Case de santé), in Marseille (Le château en santé, MSP Peyssonnel), in Strasbourg (MSP Neuhof and de Hautepierre, L'île aux santé), in Montpellier (Human santé), in Rennes (Blosne health center, MSP Nord Ouest), in Isère (Village 2 santé, AGECSA, MSP St Martin d'Hères), in Seine-Saint-Denis (La Place santé), in the Rhône (Le Jardin, Santé Commune, in the North (MSP Kruysbellaert), in the Alpes-Maritimes (MSP de l'Olivier), in Pas-de-Calais (MSP Montsoleil), in Ain (MSP des Allymes), in Maine-et-Loire (MSP des Hauts de Saint-Aubin), in Savoie (MSP Chambéry), in Vienne (Health Center of the 3 cities) or in the territory of Belfort (Acting together for our health). However, the structures included in this experiment learned of the sudden suppression of the system in April 2026. The Government claims to integrate them into common law, but nothing could be further from the truth: they will be labeled Maison France santé, for a maximum subsidy of 50,000 euros in each structure... i.e. a 90% cut in the funding ceiling! As for additional financing, it is left to the arbitrary nature of territorial negotiations with the Regional Health Agency, which does not receive an additional euro. Any financing of SECPa structures will require strip the neighboring structure. Instead of democratic and decentralized management with targeted financing, the Government is bringing health centers and homes into line by imposing on them the specifications of France Santé, i.e. classic consultations within 48 hours. Will he come for the SECPa again in the next crisis? But the foundations will be destroyed! In addition to current beneficiaries, all the coordinated exercise structures which have reorganized to become eligible for the system see their projects collapse. Rural countryside and working-class neighborhoods are undergoing a new plan, this time to close their health centers and homes. Patients and teams are plunged into the greatest distress. However, from 2025, the structures concerned requested the ministry to grant a consultation meeting and to examine their proposals for the sustainability and evolution of the system. A clear sign of government contempt: the meeting scheduled for June 2025... was held on January 29, 2026! The Government is thus sweeping away some of the most efficient structures, with disregard for patients. It destroys multi-year projects, with contempt for the professionals involved. It dismantles well-established health centers and homes, disregarding the continuity of care. Through technocratic inertia, it returns to the cult of fee-for-service pricing, that is to say that of the “health” bureaucracy, screaming contradiction in adjecto, which works to contain local and democratic innovations. She also expects the Minister to receive delegations from the 26 structures concerned and respond publicly to their alternative proposals. Will it suspend the act of execution of the structures threatened? Will it maintain additional funding for the procedure? What schedule for renegotiation of the SECPa experiment is planned? She finally asks her when she will publish the PWC report (written between December 2023 and April 2025) on the SECPa tariff model, still under embargo.

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