La concurrence entre le service public hospitalier et les cliniques privées
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Abstract EN:
A public and private sector are in competition in the realm of health care so that the french government has taken several measures in order to husband health expenses as well as to ensure a complementarity balance between the two systems (1970 and 1991 laws). These measures have been in vain because of ever-increasing medical needs in a depressive economic context, and of mutual suspicion between the two systems, so that far from abating competition is gathering force with negative consequences : the public sector paralysed by administrative and financial control and the private sector becoming "slave" to profit return, are no longer able to preserve the interests of patients and medical ethics. This critical situation has elicited number of theoretical suggestions, all tof them concluding that fondamental reforms are deemed necessary. In fact, it should be possible to define principles from which a loyal and positive competition could develop : first of all, the notion of "public service" must be demythified through the substitution of a "social interests service" able to federate both public and private systems, and to ensure eocnomic efficiency as well as respect for equity and ethics with the government only playing an arbitrating role.
Abstract FR:
La situation de concurrence entre hospitalisation publique et privee a conduit l'etat a prendre des mesures destinees a controler les depenses de sante tout en organisant une complementarite entre les deux secteurs (lois de 1970 et 1991). Ces dispositions ont echoue en raison notamment d'une demande de soins de plus en plus forte dans un contexte economique defavorable et de la mefiance reciproque des parties en presence. Loin de s'apaiser, la concurrence se renforce avec des consequences defavorables pour tous : le secteur public paralyse par le controle administratif et financier, le secteur prive soumis a la logique de la pure rentabilite economique ont du mal a concilier ces contraintes avec l'ethique medicale et l'interet des patients. Cette crise a suscite maintes reflexions, souvent contradictoire mais concluant toutes a la necessite de reformes profondes. Sans remettre en question l'existence des deux secteurs, ni leur situation de concurrence, peut-etre conviendrait-il, sur le principe d'un service d'interet social - a distinguer du service public traditionnel - de definir les regles d'une concurrence productive, qui, sous l'arbitrage impartial de l'etat, garantirait une gestion efficace des ressources dans le respect de l'equite et de l'ethique medicale.