Extract
[...] Indeed, the territories all have their specificities: Alsace benefits from a special regime, overseas territories also do, certain territories have specific geographical features (such as mountain ranges), and the legal regimes must conform to the requirements of the territory. These factual inequalities result in inequalities in the effectiveness of services. For example, transportation cannot be ensured in the same way in Ile-de-France as in the Alps. The effective practice of public hospital service can vary due to a geographical factor. Some areas are more rural than others, or are even isolated. We are seeing more and more medical deserts emerging. [...]
[...] What levers does the public hospital service have at its disposal to face the challenges that threaten its effectiveness? The representative of the Regional Union of Health Professions, composed of liberal doctors of Île-de-France, stated on December to the Parliament regarding the drafting of a bill: 'it would be more appropriate to give us means rather than obligations'. The representative then raises the difficulties in ensuring the satisfaction of health needs in the different territories. A public establishment can be understood as public law entity, other than a territorial collectivity, endowed with legal personality and responsible for the management of a public service activity within the limited framework of its specialty' (Dalloz legal terms dictionary). [...]
[...] This progress is that of decentralization. The "Hospital 2007" law, for example, introduced in 2004, introduced autonomy of public hospitals as well as more freedom in terms of management, whether from an economic, administrative or human capital management point of view." The 2010 law on the 'reorganization of Regional Health Agencies' allowed for the establishment of ARS. These are agencies that aim to coordinate all actors in the healthcare system on a given territory, whether hospitals, clinics, or liberal professionals. [...]
[...] If these guarantees are today firmly established it is worth noting that the preservation of these guarantees is a victim of the factual inequalities of the territories A. The firm consecration of guarantees for users of the public hospital service The public hospital service has defined its missions through legislative means. Article L6111-3-1 provides for very broad missions. Obviously, patient care and diagnosis, as well as the provision of care, are included. However, their missions go beyond this: proximity hospitals must coordinate the implementation of care with all healthcare personnel, they have a role as protectors of health policies and preservation of ethics. [...]
[...] Some territories are more precarious than others. We can think of overseas territories, for example. This economic precariousness can lead to technological precariousness, resulting in lower-quality care or less precise examinations. This can be a hindrance in establishing a reliable and accurate diagnosis, and consequently, in implementing an effective treatment. In addition to these risks, the threat of the private sector is added, clinics are becoming increasingly widespread and while they can be effective solutions in the absence of a hospital or when it is already full, they represent a cost that is not accessible to all and once again exclude isolated people. [...]
