The reform announcements for the Ma Santé 2022 law come after President Emmanuel Macron first announced the plans in September 2018, as part of his “global reforms” for healthcare in France.
Ms Buzyn presented the reforms to the government’s Conseil des Ministres this week, with the text now set to be scrutinised in early March, ready to be voted upon by this summer.
Many details are yet to be worked out, but some key changes are clear.
New local hospitals
The “hospital map of France” is set to be redrawn under the new law, with 500 to 600 clinics renamed as “local/nearby hospitals” by 2022. New “nearby hospitals (hôpitaux de proximité)” will specialise in general medicine, alongside care for elderly people and re-entry of patients into normal life.
Some clinics will no longer offer certain services under the new rules, with the precise details of this to be worked out within 18 months of the law’s publication.
This is intended to mean that more people have better access to general care, closer to home, but it will also mean fewer clinics specialising in surgery, and fewer specialised maternity units. Instead, these small units will be combined into fewer, but larger sites.
The closure of maternity units in particular has drawn criticism from some groups.
Yet, the health minister defended the plans, saying: “Today we already know that in many of these very small maternity units, there are no longer the professionals needed to ensure safety of care for women.”
A new healthcare data platform
The new law also sets out plans for the creation of a new data platform, which will “collect, organise and make available national healthcare data”.
This will also allow anonymised data to be collected more easily by clinical researchers, who will seek to use it to develop new groundbreaking healthcare methods, especially those linked to the development of Artificial Intelligence (AI), Ms Buzyn said.
Online and remote consultations
The government first announced in June 2018 that healthcare by phone and online video - called “télémédecine” in French - would be reimbursed by l’Assurance Maladie from September 2018.
This new law will seek to enable that further, defining it as “remote healthcare using computer communication technology that link a patient with one or several pharmacists and medical assistants”.
Nurses will also be enabled to use the system by creating a plan for patients to follow, and checking in on them regularly by phone or online consultations.
No more limits on second-year medical studies
The limit on the number of places available for second-year medical, dentistry, pharmacy and midwifery students will be removed from September 2020, to allow more people to continue their studies.
Ms Buzyn said: “We are going to increase the number of trained doctors by 20%.”
Yet, it is not clear how universities will accommodate this, as many already report that there is already a lack of both space and resources, even in first year, for the current number of students.
The minister acknowledged: “We must be able to welcome the [students] and train them, and we cannot increase dramatically in just one year.”
Following the announcement, one doctor and LREM MP, Marie Tamarelle-Verhaeghe, welcomed the statement in a press release: “Re-evaluating medical studies is a way of ensuring future professionals are matched to the diverse needs of our country. Training more doctors is necessary to guarantee access to healthcare.”
Yet, minister for Higher Education, Frédéric Vidal, said: “[This] does not mean abandoning all forms of regulation. There will still be a selection process at the end of the first year.”
No more national rankings, and easier third-year studies
The new law will also seek to get rid of national classifications for students. This system, current called “l’internat”, involves a series of exams whose results are currently used to rank medical students across the country from best to worst.
The law will reform access to third-year studies, and place less importance on this ranking system.
It states: “The second year is today mainly geared towards preparing for these exams, to the detriment of other clinical abilities of the students with regards to their professional training.”
