Hello everyone, I did my round of the news this morning, and I noted this article by Marianne yesterday. But I just saw Boursorama that the barrel of Crude WTI US had gone negative.

Barrel of WTI delivery 'May' sees for the 1^re times in the entire history of oil its price has fallen below zero.

Anyone who owns a tank truck can fill it up and get paid up to $40 per barrel carried (and the session is not over).

It's a scenario that we had sketched with you at the beginning of April, so regardless of where you look, it is clear that thewe head into the unknown.

But I think Marianne is right, we have to strike while the iron is hot, and remember why our healthcare system is not up to the standard of Germany's, and I'm not speaking in terms of involvement of caregivers, but in terms of resources.

And yet they are the ones who carry the country at arm's length… not Brussels….

Alors question yourself healthily... As well as our share to all of responsibility in this shipwreck...

can we build a better future together...

'Cause if we let them, we already know what will it give....

At least within the framework of theEuropean Union.

Reminder: a total or partial withdrawal VIDEO. “Cash Investigation”. CICE: a tax gift of 100 billion euros (France Tv Info)

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By Sebastien Grob

Hospitals have suffered nearly 12 billion euros in budget cuts in the last decade, planned by the various governments from year to year. Means that are lacking today to deal with the coronavirus epidemic.

A long bleeding before the crisis. Savings plans have followed one another in recent years in the hospitals public and private, in order to meet the spending targets set by the government from year to year. In total, health establishments have suffered nearly 12 billion euros in budget cuts in ten years. This austerity cure was greatly intensified under the five-year term of Francois Hollande, and has maintained a high level since the coming to power ofEmmanuel Macron. So many means that are lacking today to deal with the epidemic of coronavirus, while caregivers have been faced for years with a lack of beds and staff.

Austerity in hospitals is planned through a dedicated budgetary instrument: the National Health Insurance Spending Objective, or Ondam, an acronym ubiquitous in the claims of caregivers. Created in 1996 by the Juppé government, this indicator is set each year by the social security financing law (LFSS) drawn up by the executive. It serves as a framework for health policy, defining the amount of expenses that the community must bear. But without establishing a blocked envelope: reimbursements from Health Insurance are not cut if they exceed the objective. "Ondam was created to contain health expenditure, recalls Rachel Bocher, psychiatrist and president of the National Intersyndicate of Hospital Practitioners (INPH). It corresponds to a primary budgetary reasoning, rather than to a logic of care". Ondam is subdivided into sub-objectives by sector, including one for hospitals.

Rise under constraint

The Ondam increases each year, from one LFSS to another. But less than the "natural" evolution of hospital expenditure, which increases to follow the health needs of the population. "This increase is linked to the increase in the population and the proportion of people over 65, as well as the explosion of chronic diseases over the past 30 years.", details Rachel Bocher. The increase in hospital charges that would occur in the absence of new savings measures is calculated in each LFSS, and is around 3,5% per year. "And that's a low estimate“, points out Rachel Bocher. However, the increase in Ondam fixed each year is much lower, at 2,3% on average over the last decade.

A growing gap between Ondam and the natural evolution of expenditure

The difference between the two figures represents as many efforts required of hospitals. Over the last ten years, a total of 8,7 billion euros in savings was planned by the successive LFSSs. This austerity cure intensified strongly under the five-year term of François Hollande, from 2012. This can be explained by an overall context of tightening of public spending: "Ondam is part of a broader policy of budgetary rigor“, notes Rachel Bocher. The restrictions peaked at nearly 1,7 billion euros in 2017, and remained high after Emmanuel Macron came to power. Note that the LFSS was adopted in December for the next year: the savings planned for 2019 were, for example, decided at the end of 2018.
 

These budgetary objectives are implemented through a "preponderant use of price regulation levers", with "a reduction in hospital prices", as explained a senatorial report on Ondam published in October 2019. That is to say by lowering the amounts reimbursed by Health Insurance through "activity-based pricing". Set up in 2004, this system organizes the financing of hospitals based on the number and type of care they provide. A price is attributed to the various operations, which are recorded by the establishments to be used to calculate their allocations. These tariffs are revised every year by the government, and have been reduced several times in recent years to reach Ondam. Charge hospitals to compensate for this loss of revenue. In addition to this national steering, "the directors of the Regional Health Agencies are responsible for ensuring compliance with the budget provided“at the local level, specifies Rachel Bocher.

“We pay a high price”

The savings targets set by Ondam have been systematically met since 2019. And even exceeded: health insurance payments to hospitals have been several times lower by several hundred million euros than the ceiling set in LFSS, as notes the 2019 Senate report. That is 3 billion euros in additional savings over the last decade, which came on top of the 8,7 billion planned. In total, hospitals have therefore suffered 11,7 billion euros in budget cuts in 10 years.

Institutions have adapted by slashing their expenses. "This resulted in a reduction in staff and the number of beds. About 40% of intensive care beds have for example disappeared in thirty years", says Rachel Bocher. What handicap caregivers in the face of the current health crisis. "We pay a high price for the savings made during all these years, points out the president of the INPH. The need for confinement is linked to the lack of resuscitation beds. And nothing was ready in terms of equipment: we lack overcoats, masks, tests..."The cuts have also resulted in a"deterioration (...) of the financial situation of public hospitals", with an increase in their budget deficit, indicates the senatorial report on Ondam. The wave of the coronavirus epidemic finally pushed the government to loosen the noose: initially forecast at 2,1% for 2020, the Ondam was raised to 6,5%, as Olivier Véran announced on April 14 on RTL. A temporary respite?

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source: Marianne.net

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