Local Hospitals in France Mr. Dominique COLAS President of the National Association of Local Hospitals FRANCE CHICAGO, October 2015
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1 Local Hospitals in France Mr. Dominique COLAS President of the National Association of Local Hospitals FRANCE CHICAGO, October 2015
2 CONTENTS History Characteristics Activities Size Human resources Population Role of former local hospitals Incentives Future Conclusion 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
3 HISTORY 1958: RURAL HOSPITALS 1972: LOCAL HOSPITALS 2002: National plan of development, which is not applied 2009: Same status as other public hospitals 2014: New category «HOPITAUX de PROXIMITE»= Community Hospitals and among them, half of local hospitals are included 2015: New law regarding the health system and hospitals, which does not deal particularly with community and local hospitals 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
4 CHARACTERISTICS Community hospitals (CHs) will have: A medical service, a limited number of stays (1000?) No obstetrics departments No surgical units An emergency unit, when applicable Regarding the others, they will belong to a group of public hospitals in their area. 300 CHs among which 156 former local hospitals 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
5 CHARACTERISTICS CHs encompass two kinds of hospitals: Small general hospitals Employing salaried doctors exclusively Taking care of all kinds of patients, of all ages Former local hospitals Including mainly family practioners as well as salaried doctors Taking care quite exclusively of the elderly It does not include former local hospitals only offering physiotherapy and/or long term stay 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
6 FORMER LOCAL HOSPITALS 350 in 2004, around 300 in including a medical unit, 156 in 2015 Uneven distribution 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
7 «Le MONDE» /10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
8 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
9 ACTIVITIES: CARE Hospital services: Medical unit Physiotherapy Long-term care Palliative care (no radiology, no laboratory but a pharmacy ) In-home medical care In-home paramedics and nursing care Mobile teams (nurses, psychologists, occupational therapists for families and close relatives, for the patients suffering from Alzheimer s or neurological diseases) 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
10 ACTIVITIES: PERSONAL CARE SERVICES Delivery of meals Home help 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
11 ACTIVITIES FOR THE ELDERLY Retirement home Nursing home and temporary stay Day or night stay Former local hospitals are part of the geriatric network of care, located as closely as possible to the population 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
12 SIZE The average size is: CARE MEDICINE 13 beds PHYSIOTHERAPY LONG TERM STAY 25 beds 35 beds HOME 135 beds TOTAL 208 beds The size goes from 100 to 800 beds. 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
13 HUMAN RESOURCES: DOCTORS The trend is to have more salaried doctors Full time equivalent: 48 hours/week. Unit less than 10 beds: 0.3 FTE Unit more than 20 beds: 0.75 FTE (1 in physiotherapy) Also salaried pharmacists The others are family practitioners Paid by the act (22 $) From 1 to 15 and more On average, from 5 to 9 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
14 HUMAN RESOURCES: NURSES and PARAMEDICS The nurse staff ratio is equivalent to one Full Time Equivalent per bed. Nurses represent 1/3 of the staff Nursing auxiliaries or nursing aids: 2/3 0.6 FTE in retirement homes In complement: Some physical therapists Psychologists Occupational therapists Dietitians 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
15 POPULATION MEDICINE: The average age is 73.5 for men (1/3), 80.4 for women (2/3) 61.4% of the hospitalized population is over 80 The average length of stay is 13.6 days Activities: Palliative care Respiratory system Mental diseases Circulatory system Traumas and musculoskeletal disorders Alcoholism 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
16 ROLE of LOCAL HOSPITALS Desertification in France: demographic decline and public services decreasing in rural areas. Increase in life expectancy: the French are growing older, 85.4 years old for women, 79.2 for men 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
17 PLANTU, /10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
18 ROLE of LOCAL HOSPITALS The presence of a structured organization for health in rural areas has positive effects: not only are retired doctors replaced, but new ones are also starting their medical practice. Doctors and other health professionnals work together, hand in hand. Certification increases the skill of all. Some organizations are very often supported by local hospitals: For the continuity of care focused on outpatients and small emergencies For the coordination of the health network For a local health project 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
19 INCENTIVES In 2013, a plan to fight medical deserts was elaborated by the Department of Health. Two mesures are related to hospitals, but nothing really happened and local hospitals continue to see their medical units closing one after the other. We are now waiting for a change in the allocation of resources. Their budget are currently based on flat rates. They may become mixed: flat rate and in correlation with the level of activity. Nevertheless, some hospitals are rebuilt, but with a decrease in their activities and capacity. 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
20 FUTURE «Favorable» context: People are older More chronic diseases Patients want: High quality care: the certification shows that our results are quite good Professional care Very human care Services close to their home Local hospitals also provide: Less expensive care Longer stays than in the other types of hospitals 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
21 FUTURE We can offer and develop the care we already provide and expand on the principles of: Subsidiarity of the care A niche market As examples: Palliative care for inpatients and at home Wide coordination in charge of the elderly from home to the hospital and back More specialized consultations in connection with bigger hospitals Development of psychiatric units and the addiction care Dialysis, radiology and medical imaging Comas and eating disorders Of course, telemedicine will be very helpful Not only for the elderly but also especially for children Not only in the country, but also in the city. 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
22 CONCLUSION We could do great things for a better and more human world Yet, what we need first is a clear vision at the national level as well as a real and encouraging policy. Thanks for your attention and SPECIAL THANKS to and PLANTU for the drawing he did for this congress 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
23 Mr.Dominique COLAS Centre hospitalier de LAMBALLE 13 rue du Jeu de Paume LAMBALLE,France Bachelor of Economics Master of French literature National School of Public Health (director of hospital),rennes Graduate of the Hight Studies of modern Africa and Asia Director of the «Groupe Gériatrique du Penthièvre» President of the National Association of the local hospitals (ANCHL): International expert,mainly in Western Africa and in South East Asia 19/10/2015 CHICAGO/ IHF /ANCHL/D.COLAS/ october
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