Hospital, patients, health, territories is the official name of a French bill presented on 22 October 2008 by Roselyne Bachelot, minister of Health, Youth, Sports and Associative Life. The bill is commonly called bill HPST (acronym of the French phrase) or bill Bachelot. The bill is the first stage of the Hospital 2012 Plan, launched by French President Nicolas Sarkozy, aiming to revamp the French health care system. The bill seeks to guarantee better and equal access to care for all French people, regardless of their geographic location. This reform needed a complete overhaul of the hospital's organization, which caused strong protests among the staff.
Initial project The bill contains four main points, as defined by its official title. It would modernize the hospitals, giving them more financial means to carry out their mission and rehauling their territorial and internal organization. It would also favor research and education. Care provision would be reorganized through coordination between hospitals and cities to guarantee better access to care. The bill would also organize it at a regional level. It would finally reinforce prevention against all addictions, especially for young people and women.
Prevention The bill focus on measures to improve the health of young people.Présentation du projet de loi « Hôpital, patients, santé et territoires » , Ministry of Health, Youth and Sports Minors (less than 18) would be forbidden from drink alcohol, and encouraged to eat fruits and vegetables.
Access to health care
The bill would favor better access to good-quality care by implementing a better distribution of doctors throughout the national territory. The provision of care would be organized at a regional level. Financial incentives would be provided in regions lacking health care to appeal to doctors. Private sector practitioners fear the bill would limit their freedom of installation.
The bill finally implements strong decision-making authorities in hospitals, stating that there is currently no defined executive power. Directors will, therefore, see their powers strengthened at the expense of the boards and local elected officials. They will control the hiring of doctors and their pay. Modernisation of hospitals
The opening of frontiers between hospital and city medicine is a more controversial point. The bill would cause the mergings and reconversion of many hospitals and the specialization of care provided by some hospitals. Resources and technical means would be polarized in significant hospitals. At the same time, small structures are encouraged to find other orientations and to specialize, notably in the rehabilitation of disabled people and in the care of older people. Also, private organizations will be forced to provide their care to any people, acting as a public service.
Territorial organization On a larger scale, regional health agencies will be implemented. They would centralize powers currently exercised by health agencies such as Regional Hospital Agencies (ARH), the Ddass or Health Insurance. Led by the regional prefects, they would manage the overall delivery of care, whether private, hospital or medico-social.
Immediate reactions Professionals and health care users have reacted to the bill Bachelot.
Modernization Reactions over the modernization of the system were rather negative. The trade union Sud-Santé have expressed concerns about the future of the French health system, arguing the law would submit it to capital gains.Pour le retrait du projet de loi Bachelot, Sud-Santé The organization denounced the dismantling of health public service and the privatization of health care institutions.official tract, Sud-Santé The Confédération des syndicats médicaux (CSMF) greeted the expected reform of the hospital brought by the bill, which would finally reorganize and modernize the whole system, but denounced the "nationalization" of the health system, arguing the future regional health agencies will be omnipotent.Projet de Loi HPST : il faut agir là où sont les besoins de réforme, CSMF The CSMF proposed various amendments.Proposed amendments, CSMFAmendments included in the bill, CSMF The Coordination to defend public hospitals declared they were satisfied by the modernization of the system but feared the bill would liberalize the provision health care.
Territorial organization There was also discontentment about the reorganization of the system on a regional level (creation of ARS). The National Coordination Committee for the Defense of hospitals argued the reform would worsen the unequal access to care, depriving a portion of the population from health services.official tract against the bill , Coordination Nationale des Comités de Défense des Hôpitaux et Maternités de Proximité They condemned the closure of hospitals planned by the bill.other pamphlet , Coordination Nationale des Comités de Défense des Hôpitaux et Maternités de Proximité The Interassociative Committee on health (Ciss) approved of the end of little structures, judged as dangerous. The organization is dubious about the quality of care provided by these establishments.Propositions to improve the bill , Ciss
Access to care The measures to improve the access to care were also subject to controversy. The National Federation of Workers and disabled (FNATH) approved of the reform of the hospital, but They announced they would propose amendments to ensure the presence of representatives of patients in the supervisory boards of the hospitals. Practitioners fear the bill will liberalize the system with financial constraints for them.Loi Bachelot : le rejet massif des médecins, CSMF There was a massive rejection of the bill by both private-sector and public-service practitioners.Médecins libéraux et hospitaliers : deux fronts contre le projet de loi HPST, CSMF The CSMF said the bill would impose a "tax" for medics working in densely populated regions with many infrastructures and resources.Taxe Bachelot : la Ministre de la Santé persiste, la CSMF aussi, CSMFTaxe Bachelot : la CSMF dénonce l'escalade dans la croisade anti médecine libérale, CSMF However, the Hospital federation (FHF) have fully approved the measures for medics.
Health The measures on alcohol were less polemical. The FNATH expressed their disappointment, having expected measures about health at work.Réforme de l'hôpital: les propositions de la FNATH (29/11/2008), FNATHPropositions to improve the bill, November 2008 , FNATH The National Association of prevention of addictiveness and alcoholism (Anpaa) has given its full support to the measures limiting alcohol for young people.
Timeline of events
Presentation of the bill and first reactions. The bill was first presented in the Council of Ministers on 22 October 2008 by Roselyne Bachelot, minister of Health, Youth, Sports and Associative Life. Organizations, Committee and trade unions, coordination's and associations of the health sectors gave their immediate reaction to the bill and began to work on propositions to improve the bill (amendments). Discussions by the deputies. From 10 February 2009, the law was debated by the National Assembly. The deputies began discussions on the Title II of the bill on 2 March. The bill was adopted by the deputies on 18 March after long debates. Strikes and demonstrations. Before and during the discussions in the Lower House, various strikes and demonstrations were organized. The health sector went on strike on 29 January.Tous contre la loi Bachelot !, Sud-Santé The Trade Union Sud-Santé called for new strikes for 12 FebruaryPour le retrait du projet de loi Bachelot, le 12 février tous dans l'action !, tract for the 12 February strike, Sud-Santé and 5 March.Loi Bachelot, arme de destruction massive des hôpitaux !, Sud-SantéRetrait de la loi HPST une exigence vitale pour l'avenir du service public de santé ! for the 5 March strike, Sud-Santé The professionals of the health sector also participated in the national strike and regional demonstrations on 19 March, such as the Union syndicale des médecins de centre de santé (UMSCS)Official tract for the 19 March strike, National Coordination and the Coordination nationale Contre la « politique de la peur » et la casse sociale, Manifestons ensemble le 19 mars, official tract for the 19 March strike, National CoordinationPour un système de santé solidaire, exigeons le retrait de la loi Bachelot! , National Coordination The call of the 25. On 16 April, 25 professors of Parisians hospitals (AP-HP) launched a call, known as the "call of the 25".The call of the 25 as published in the Nouvel Observateur They rejected the measures on public hospitals. In particular, they opposed the new management of hospitals, with omnipotent directors. They also denounced the financial constraints imposed to the hospitals. The 28 April demonstrations. On 28 April 2009, a massive strike and several demonstrations in the country were organized by various associations, just one day before the April 29 nationwide mobilization. There were 20,000 hospitals professionalstoll claimed by the organizations Sud-Santé (professors, nurses, medics, marching to protest against the Bachelot law. They demanded the quality and the equality of access to care, criticized the transformation of hospitals into lucrative. The move was initiated by Public Assistance - Parisian Hospitals (AP-HP), willing to protest against the suppression of jobs, the closure of hospitals and the strengthening of the executive in hospitals. Many organizations followed the initiative: the Coordination médicale hospitalière (CMH), the Syndicat national des médecins, chirurgiens, spécialistes, biologistes et pharmaciens des hôpitaux publics (Snam HP), the conférence des présidents des commissions médicales d'établissement des centres hospitaliers universitaires (CME-CHU), the Union syndicale des psychiatres (USP) and the Coordination nationale infirmière (CNI), who called for a 24-hour strike. The participants wanted to defend the health public service and rejected the new management of hospitals. It was also meant to pressure the Senate, which was to examine the bill soon after. The Marescaux report. After the 28 April strike, senators of the majority declared they would modify the bill so as to satisfy the health professionals. The President of the Senate Gérard Larcher announced the senators would take into account the concerns of the demonstrators. On 8 May, a senatorial commission released a report which opposed the measures concerning the executive in hospitals included in the bill. President Sarkozy declared on 11 May he was favorable to the measures proposed by the report, but refused to concede further modifications of the bill. He announced the government would pass amendments to reform the bill. Discussions by senators. The bill was discussed by the Senate from 11 May 2009. Around one thousand and five hundred amendments had been deposed before the opening of the debates. Discussion on the legal procedure. The initial procedure to pass the bill allowed only one series of discussions for each house of the congress ("urgency procedure"). However, deputies of the National Assembly expressed their desire to reexamine the bill after the senatorial discussions. Several associations and organizations of health professionals also demanded the change, so as to have a real debate on the bill. On 13 May, the President of House Bernard Accoyer asked the French President Nicolas Sarkozy and Prime Minister François Fillon for permission to discuss the bill, and he was told if the Senate changed the bill considerably, as it announced, the bill would be reexamined. Roselyne Bachelot expressed her opposition to a second series of discussions, arguing the Senate only completed the bill without transforming it.