Invited this Tuesday morning on France 2, the socialist presidential candidate, Anne Hidalgo, affirmed that “the government has eliminated 5,700 beds (of hospitals) in France while we are in the midst of a pandemic”. An assertion which is not inaccurate, but which deserves to be contextualized.
Monday evening already, the deputy of the Somme François Ruffin, close to rebellious France, made a similar declaration to the National Assembly, during the debates on the vaccination pass: “In 2017 you closed 4,900 beds, in 2018 4,200 beds , in 2019 3,100 beds, in 2020, 5,700 closed beds, you beat your record in the middle of the Covid year, ”he told Minister of Health Olivier Véran.
According to a study of the Drees (the Directorate of Research, Studies, Evaluation and Statistics, attached to social ministries) published at the end of September, France had 386,835 full hospital beds in 2020, or 5,758 less than the previous year. As this report confirms, thousands of beds had already been closed since the start of the Macron five-year term (4,919 in 2017, 4,165 in 2018 and 3,108 in 2019).
75,000 fewer beds in sixteen years
The figures put forward by Anne Hidalgo and François Ruffin are therefore correct. But they ignore the bed closures that occurred in the years before the current government came to power. According to another publication from the Drees, “Between 2003 and 2019, the number of full hospital beds installed, all establishments, all disciplines and all sectors combined, fell from 468,000 to 393,000”, ie 75,000 less (see graph below). However, between 2003 and 2019, four presidents from different sides followed one another: Jacques Chirac, Nicolas Sarkozy, François Hollande and Emmanuel Macron.
The drop in the number of full hospital beds observed in 2020 therefore continues “a trend observed for several years”. According to DREES, this decline is primarily due to “the desire to reorganize the offer in a context of ambulatory shift”. Clearly, advances in medicine have made it possible to reduce hospitalization time in some cases. Where possible, patients no longer sleep in hospital, which helps reduce costs. Between 2003 and 2019, 29,000 partial and incomplete hospital beds were thus created.
However, the Drees recognizes that the decrease in the number of full hospital beds “is a little more marked in 2020 than during the period 2013-2019” (-1.5%, against -0.9% per year on average). A phenomenon which “could be explained by the context of the Covid-19 epidemic”.
The Covid has amplified the closures
The Drees study published at the end of September recalls that the health crisis has “led to the deprogramming of many hospitalizations” and that “many double rooms (have been) transformed into single rooms to limit contagion”. In the latter case, the closed beds have not been closed definitively.
Another element, of a practical nature, makes it possible to put into perspective the drop in the number of hospital beds during the pandemic, and more precisely in 2020: the Drees only counts the number of beds on December 31 of each year. “The temporary deployment of beds to deal with the pandemic is not therefore systematically found in this inventory at the end of the year, if they were closed at the beginning of December for example”, indicates the Drees.
Finally, its administrative investigation points to “staff constraints that do not allow the beds to be maintained”. Harsh working conditions, low wages … the shortage of caregivers is also part of the equation.
Moreover, it is not only in France that hospital beds are closing. According to the 2021 Health Panamora established by the OECD, the vast majority of the 42 countries studied lost hospital beds between 2009 and 2019 (see graph below). France is also the tenth country with the most beds per capita, behind Japan and Germany but ahead of the Scandinavian countries.