Question 24082 — overseas

Summary

Mr. Jean-Philippe Nilor questions the Minister of Solidarity and Health about health establishments in the Antilles and Guyana. Based on the observation of the clear deterioration of the situation in these hospitals, the Guadeloupean deputies Justine Benin and Max Mathiasin (Modem), the senator Dominique Théophile (LREM), asked the Minister for a revaluation of the geographical coefficient relating to health establishments in the Antilles and in Guyana. Currently, the latter is set at 27% in Guadeloupe and Martinique, 29% in Guyana, 31% in Reunion and Mayotte and 11% in Corsica. Although timely and realistic, this measure, if adopted, would have constituted an appreciable first step in managing the crisis. However, it would be insufficient to resolve in a lasting manner the structural deficit of hospitals in the French Overseas Territories. Moreover, the emergency strike, which lasts for several months, and the predictable health consequences of Brexit on health, rhyme with what is experienced in the Antilles: they illustrate the particularities of the health situation in these regions, concretize the threats weighing on health in Martinique, as in Guadeloupe. The problems, exacerbated by geographical distance, can, directly or indirectly, influence the level of health of Martinicans: the increase in prices, the tight supply of medicines, medical devices and laboratory reagents, the lack of maintenance of equipment, the accelerated degradation of materials linked to the tropical climate, a population pool that is too narrow for activity-based pricing. If we complete the picture with the incidence of the medico-social consequences of accelerated aging of the population (Martinique is the oldest department in France), an unemployment rate of 50% for 15-25 year olds and a population of which 30% lives below the poverty line, to name only these elements, we can measure the explosive nature of the situation. Due to the insular nature of the economies of the overseas departments, the obligation to have at least two additional months of supply, in addition to the usual stocks, is a necessity. management. However, this requirement has strained hospital finances for more than 10 years. Added to all these problems is the massive use of temporary doctors or clinician contracts (particularly in emergencies), which end up drying up cash flow. The emergency crisis is in fact the crisis of the health system, which has also spread to the entire hospital system, and even to society as a whole. And the solutions that could emerge to get out of it will not be enough to resolve the crisis that has been undermining West Indian hospitals for years. Only a major response can restore financial viability to hospitals and confidence among the population in the quality and safety of the care they can provide. This can be based on the following proposals: a revision of the geographical coefficient mitigating the impact of DOM additional costs (excess remuneration of 40%, transport costs, dock dues, bank margins, etc.): currently 27%, it was calculated by the University Hospital of Martinique in 2016 at 37.79% and represented 60.3 million euros in 2015, to which should be added an operating loss of 31 million euros per year; move away from the 100% T2A logic by ensuring a fixed financing base and a part (why not 60%?) in T2A; a medical school full practice to increase the attractiveness of medical and paramedical careers; an upgrade of hospital buildings and accommodation establishments for dependent elderly people; an adequacy of medical and surgical beds to the real health needs of the population, with particular attention to geriatric and psychiatric sectors; a paradigm shift in governance, giving a real power to caregivers, sanctioning the principle of the hospital enterprise and the “systemic breakdown” denounced in the multiple IGAS reports at the origin of 30% of the deficit; the creation of active medical-social centers operating identically to those in mainland France. An alternative to healthcare structures which is symptomatic of the discrimination and territorial inequalities suffered by populations and overseas regions, because how can we explain such treatments? Consequently, he asks her how she intends to address the problems facing these populations, in order to take all measures likely to respond effectively and sustainably.

Machine translation from French. The official text remains authoritative.

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• Jean-Philippe Nilor · auteur

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