INFOGRAPHICS. How France has lost nearly 80,000 public hospital beds in twenty years – franceinfo

About 20% of hospital beds are said to be unused for lack of staff. This is the figure put forward on October 26 by the flash survey conducted by Jean-François Delfraissy, the president of the Scientific Council. Carried out at the beginning of October, this investigation raises questions, after more than a year and a half of the Covid-19 epidemic which has placed very significant pressure on French hospital services.

But the downward trend in the number of hospital beds in France is not new, especially in public establishments. Franceinfo gives you details of this evolution thanks to several graphs.

Since 2000, the observation is clear: French public medical establishments have lost 79,896 hospital beds, i.e. a quarter of their reception capacity, according to data from the DREES consulted by franceinfo. This decrease can be observed everywhere in the territory, since all the departments of hexagonal France have seen the number of hospital beds in the public drop, with the exception of Val-de-Marne.

In some rural departments, this number has even been almost halved since 2000. This is the case of Alpes-de-Haute-Provence, Creuse or Sarthe, which respectively show 44%, 45% and 48% drop. The largest drop in the number of beds in public establishments is observed in Ardèche, which fell from 2,460 to 1,132 beds, a decrease by 54%.

The geographical distribution of this decrease can also be visualized by comparing the map of France of hospital beds between 2000, 2010 and 2020. Each point represents a city where there is a health establishment with hospital beds and the size of the hospital. point is the number of beds.

Two phenomena are visible on this animation. The first is the overall decrease in the number of beds, visible by the narrowing of the points; the second is the reduction in the number of public establishments with hospital beds. We go from 1,019 in 2000 to 932 in 2010, then 803 in 2021. This corresponds to the red dots, which are gradually disappearing.

How to explain this drop in the number of beds over the last twenty years? Contacted by franceinfo, the Directorate of Research, Studies, Evaluation and Statistics (DREES) gives several reasons. The first is the change in the care of old age with the transfer, during the 2000s, of many beds from long-term care units (USLD) to nursing homes, assures the body responsible for collecting these. data for the Ministry of Health. The latter do not appear in the figures since they do not have a treatment authorization, the criterion set by the DREES to include an establishment. But that is not enough to explain the overall decline, since these USLDs represented less than 15% of beds in 2000.

The other reason put forward is what is called the “ambulatory shift”, ie the shift from a hospital-centered system to greater use of general practitioners and home hospitalization. This transfer automatically reduced the number of beds opened in hospitals. For Rachel Bocher, president of the INPH, the first national inter-union of hospital practitioners, “The ambulatory shift is perhaps a good thing, but the public hospital must also be able to have the capacity to cope with periods of crisis, as we have experienced with the Covid”.

And in the event of a crisis, to have an operational hospital bed, you need equipment but also the staff to take care of it. Rachel Bocher points “a lack of attractiveness for the profession [de soignant], for lack of remuneration and with extended hours which put off many young people “. Jean-François Cibien, president of the intersyndicale Action hospital practitioners, underlines for its part the problem of specific remuneration in the public hospital.

“In the private sector, I am offered to triple my salary by working half the nights a month.”

Jean-François Cibien, president of the intersyndicale Action hospital practitioners

to franceinfo

The figures show that the decline in the number of beds is more significant in the public sector. When public establishments have seen their capacity drop by 25% in twenty years, this drop was only 3% in the private for-profit sector, that is to say generating profits (clinics). The private non-profit sector (associations or foundations) is experiencing an evolution closer to that of the public, with a drop of 21% over twenty years.

For Jean-François Cibien, this decrease in the number of beds has direct consequences on the care of patients, with “a risk of delay in care and support which can reach six months or even a year”. He also denounces a policy, absurd according to him, of rationalization of costs in the hospital which could prove to be counterproductive: “If a patient goes home earlier for lack of a bed, and he finally has to come back urgently a few days later, this generates an additional cost of transport.”

The two union representatives estimate that the announcement of an investment of 6 billion euros in the health system, made during the Health Segur in July 2020, goes in the right direction but that we must go further. They are very worried about the situation in the short term, because to compensate for the lack of caregivers, they must first be trained, which necessarily takes several years.

Methodology. The data used for this article come from the SAE survey conducted annually by the DREES, and more particularly the “Long series” file. The latter provides for each year between 2000 and 2020 the number of hospital beds per establishment. Over the twenty years, the methods for collecting the data may have evolved, but this does not cause any disproportionate variation in the figures over a year, whether in the number of hospital beds or establishments having them. On the contrary, these two indicators decline continuously over the entire period observed.

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