“There will be no more emergencies, no more births, no more admissions…” From June 3, the five private clinics in Gard are on strike

Valérie Bazin, directrice opérationnelle de la PGS, Valentin Viala, directeur de la clinique Valdegour, et Floriane Nambert, directrice de l’ICG et de Bonnefon à Alès. Midi Libre – K. H.

Valdegour, PGS, Franciscaines et ICG, à Nîmes ; Bonnefon à Alès : les cinq cliniques du groupe Elsan cessent leurs activités du 3 au 5 juin. Un mouvement (national) reconductible.

The fever is rising in the clinics! The private hospitalization federation (FHP) is standing up against the new 2024 pricing announced by the Ministry of Health. Two figures to summarize the situation which makes one cringe: the increase in funding for the private sector is 0.3% and 4.3% for the public hospital.

"0.3% increase, it's incomprehensible"

In Gard, the Elsan group is mobilizing and announces that the strike will be followed in its five clinics: the Grand Sud polyclinic (PGS), Valdegour, the ICG and the Franciscaines, in Nîmes, and Bonnefon, in Alès. Gathered at the Grand Sud polyclinic, the directors explain the reasons for the anger."We also expected an increase of 4.3 %. The government had made promises in relation to inflation, especially since the increase in night and weekend hours has not been implemented for the private sector. quot;, deplores Floriane Nambert, director of the Bonnefon clinic and the Gard Cancer Institute (ICG) which is in co-management with the CHU.

Maternity and emergencies, services under pressure

Maternity and emergencies are underfunded services and regulatory constraints are heavy. "80% of the cost of' hospitalization corresponds to the first 48 hours, surgery, resuscitation, qualified personnel… that doesn't change!"

"In the maternity ward, we need a pediatrician, an obstetrician, two midwives, an operating room nurse, details Valérie Bazin, from the PGS."Today, what penalizes us the most is motherhood. Until when will we be able to support it with a deficit? The desire of the Elsan group is to maintain it but if it closed, could the University Hospital absorb 1  additional births per year? an ?", asks Floriane Nambert.

The closure of clinic emergencies from June 3 to 9 will impact the hospital. At the Bagnols hospital, emergencies are under pressure, in Nîmes, there are 500 visits per day. How will they be able to absorb hundreds of additional patients ?

"40% of medical activity in Gard"

"We balance between worry and incomprehension", insists Valérie Bazin, the operational director of the Grand Sud polyclinic (PGS). In Gard, clinics represent around 40% of medical activity, with 76,000 patients per year plus 27,000 for emergencies (35% of total medical activity). ;rsquo;activity and nine million patients nationally).

The cessation of activity from June 3 to 5 has been completely announced in the Gard. "There will be no more entries, surgery, chemotherapy, maternity, cardiology…", lists Valentin Viala, director of the Valdegour clinic. And for emergencies, the movement is planned until June 9. "Employees have validated the cessation of activity in CSE. The clinics will lose turnover but in any case we are already losing money,they add with one voice. At the national level, private hospitalization expects a movement followed at 90% in 1030 establishments. And five out of six doctors’ unions are also mobilized.

"We work hand in hand with the CHU"

A mobilization which will have a big impact on hospitals forced to absorb part of the clinic activity in an emergency. "We are not in competition with the public hospital, insists Floriane Nambert. The two are complementary but when we weaken the private sector, the entire health system is impacted. The private sector represents 40% of activity but only 18% of the budget.

"And 90 % of our revenue comes from Health Insurance", adds Benjamin Viala, the director of the Valdegour clinic who demonstrates the diagram at l&rsquo ;support that public/private rates have evolved in the same way since 2000 before a severe decline in recent years.

"We have a complete range of care and we really work in conjunction with the University Hospital, completes Valérie Bazin. At the PGS maternity ward, they send us babies when their neonatal department is full, for example. We are in a daily partnership, and that's normal."

Wage inequalities

The Ministry of Health's argument to justify this price difference is that the post-Covid resumption of activity was much greater in clinics. Covid has also accelerated the conversion to outpatient care. "But more activities also means more staff and equipment therefore expenses. And more ambulatory means less revenue, unravels Valérie Bazin. In fact, there was a 10% increase in activity but only 4% in turnover. "Because inflation obviously also affects us. The price of surgical equipment has thus increased by 50%.

The University Hospital is strengthening its teams to cope

How to absorb in good conditions patients who will not go to the PGS emergency room from June 3 to 9 or deliveries who will no longer be covered from June 3 to 5 ?
The Carémeau University Hospital is putting itself in “order of battle”. « Since we were informed of this strike, the University Hospital teams have been working on several scenarios depending on the level of activity in the private sector, in order to guarantee the population continuity in patient care. .

President of the Establishment Medical Commission (CME), Professor Michel Prudhomme is in contact with his fellow CME presidents of private clinics in order to determine the right level of mobilization, explains- we at the CHU.

The emergency, SAMU and obstetrics and gynecology services will be reinforced if necessary by additional staff of doctors and caregivers.
Four doctors, two midwives, nine paramedics and two medical regulation assistants will be mobilized during this period, « i.e. 17 additional professionals per 24 hours. More generally, the entire hospital is preparing for a significant reduction in care in clinics. »
This anticipation is carried out with the territorial delegation of the ARS and in coordination with the other public health establishments in the territory as well as private medicine.
The CHU aims to be reassuring for patients: « We will respond in all circumstances as we did during the three years of the Covid pandemic.

Clinics in deficit

The risks of this"underfinancing" are multiple, they explain. On employees first while salary inequalities with the public are widening. "A nurse in the public is paid 400 € more per month. And structurally, many clinics already in deficit will find themselves in great difficulty. With risks of closing certain services. 40% of private clinics were in deficit at the end of 2023, the FHP estimates that they will be 60% at the end of 2024.

And Gard is no exception. In Bonnefon, the 2024 forecast budget which counted on an increase in health insurance prices of 3% would have already shown a net result of minus 900,000€.  "But ultimately with 0.3 %, the deficit will be 480 000 € additional", deplores Floriane Nambert. At the PGS, the losses stand at 1.20 million euros, at the Franciscaines and at Valdegour around 500,000 euros. "Until what price can we maintain a complete healthcare offer ?", asks Valentin Viala.

"We want a multi-year plan"

What private hospitalization requires ? "For 2024, prices will no longer change. We want an envelope of 500 M€ in an emergency but above all a multi-year plan with real funding for the future. To invest, we need visibility in the medium term", says Floriane Nambert who does not hesitate to see into the government's choices &quot ;a political will to unravel the private sector while in France we have a super health system that walks on two legs!"

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