The cities want to rely on local contracts to public health

While the content of the draft law on the organization of the health care system - in particular the provisions relating to future regional health agencies (ARS) - became clearer every day, local authorities are taking their brands to position itself in a reform that the government as a "turning point in our health policy." After small towns (APVF), medium-sized cities (FMVM) and big cities (AMGVF), it is the turn of the national association of cities for the development of public health Elected, public health and territories (PTSD) taking a position. In a press release dated March 13, PTSD thus its expectations regarding the creation of regional health agencies. The association supports the principle of ARS, powers much larger than the existing regional agencies of hospitalization (ARH). But she said that their implementation must meet three challenges. The first is to "make the organization of the provision of care, both private and public health needs of the population declined by territories and priorities of the PRSP [regional plan for public health]." The second issue highlighted by PTSD - and which will determine its final support for the reform - is to "implement the new policy by regional health contracts local public health" (already proposed last October by the City and suburbs for urban areas). PTSD hopes that the new approach to resume the city health workshops, involving all three levels of local governments. The third point concerns the place of communities in the LRA, which is still very unclear in the current bill. The association intends to "make local politicians of full members of the executive and the board of directors of ARS future." The judge in effect "ridiculous" the current participation of local elected officials in the preparation and monitoring of regional health organization plans. It is not clear whether the association will succeed on this point. Despite the expansion of their powers, the LRA remain very focused on the planning and organization of the provision of care, financed almost exclusively by the Health Insurance agencies and the Supplemental health protection. At the moment, community interventions are summarized mainly to participation in public health activities, to the financing of aid for health professionals (in LFA), and for some communities, participation the financing of investments in hospitals or tools for ongoing care of the city (such as medical care homes). If local authorities are now well represented in regional groupings of Public Health (two representatives in the region, a general councillor by department and four representatives of Commons), they can expect a similar presence within ARS, skills largely beyond the sole public health. The State and the Insurance - in their qualities of supervisions and main financers - appear to be determined to limit their role in decision-making bodies. Furthermore, the establishment of ARS may well sound the "revenge" of departments. In the first sketches agencies, the emphasis was primarily on the regional level and on major cities and intermunicipalities. But the announcement, in the wake of the report Ritter, as well ARS encompass facilities and services sector médicosocial radically change the situation. Difficult indeed, in these circumstances, not to grant a significant departments, which allow, tarifient and finance - alongside the Health Insurance - a large part of these structures. The struggle for representation in the councils of ARS promises to be particularly hot.