Question 15279 — health

Summary

Mr. Stéphane Rambaud draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the structural limits leading to serious dysfunction in the approval system for medical transport companies issued by the ARS. The current regime for authorizing the entry into service of medical vehicles is based on a system of territorial quotas conditioning the allocation of ambulance approvals. If this system allows administrative regulation of the number of vehicles, it today reveals significant operational, territorial and economic limits. In the Var department, as in many French territories, medical transport professionals note a growing mismatch between authorized means and the real needs of the population. Demographic aging, desertification medical, hospital tensions as well as the evolution of health mobility needs do not seem to be sufficiently taken into account in the evolution of quotas. This system thus leads to significant imbalances between territories. Certain urban areas are experiencing saturation in the number of ambulance companies, generating excessive competition and a drop in profitability, while other sectors, particularly rural or semi-rural, remain under-resourced, with prolonged intervention times and increasing difficulties in accessing care. In the Var, this situation is reflected in particular by tensions linked to transport distances and the organization of scheduled journeys. However, the findings made in this department are found, in comparable forms, in numerous territories of the Republic. Furthermore, the rigidity of the system current situation leads ambulance companies to develop adaptation strategies to maintain their economic balance. Some operate regularly in neighboring departments, specialize in the most profitable scheduled transports, notably dialysis or chemotherapy, or favor long-distance journeys. Others seek to develop mainly through the repurchase of existing authorizations, due to lack of of possible creations when quotas are reached and become the only path to development. Although these practices generally remain legal and supervised, they nevertheless reflect the limits of a system considered too rigid, difficult to read and insufficiently adapted to territorial realities. The criteria for granting authorizations also often appear opaque for professionals, relying both on data statistics, historical situations and administrative decisions that are difficult to anticipate. This is why he asks her if she intends to initiate a structural reform of the system of approval of medical transport companies in order to put an end to these dysfunctions, strengthen the transparency of the criteria for granting authorizations and guarantee a more balanced distribution of the medical transport offer across the entire country. national territory.

Machine translation from French. The official text remains authoritative.

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