François Bayrou’s new administration in France, sworn in after the previous, three-month-old government was toppled by a no-confidence vote, brings a new health minister to a post recently characterized by instability. With budget concerns looming and the doubtful staying power of the new cabinet, it remains to be seen how much he will be able to bring about change in France’s ailing healthcare system.
Lack of Stability
When cardiologist and MP for the Isère region Yannick Neuder of the conservative party, Les Républicains, took office at the end of December, he fell heir to issues that have long riddled the French healthcare system and to a ministry that has seen an ever-changing succession of legislators. With no less than seven ministers passing on the health baton in the two and half years of president Emmanuel Macron’s second term, the country’s healthcare professionals have suffered from a continued lack of government stability. “This ministry has experienced many changes and upheavals. Too many, without a doubt,” said the outgoing minister of health Geneviève Darrieussecq, who held her position for just three months and seven days.
Stakeholders have expressed their frustration at these constant changes and the consequent impact on long-term planning. “Our institutions urgently need budgetary visibility to continue fulfilling their public service mission, especially in preparation for the 2025 budget campaign. With a cumulative underfunding of EUR 1.3 billion, the situation on the ground is particularly difficult,” lamented the French Hospital Federation (FHF).
Most agree that a new approach is required to resolve critical issues plaguing the system. These include chronic understaffing and medicine shortages. “Our healthcare system is in a catastrophic state. If we’ve reached this point, it’s because the health policies that have been pursued to date have failed,” said Jérôme Marty, president of the UFMLS, a union representing self-employed doctors. But will Neuder, placed under the supervision of Catherine Vautrin, the head of a much larger portfolio that includes not only health, but labour, solidarity and families, have the capacity to drive this sorely needed transformation?
Tackling “Medical Deserts”
The new minister is inheriting a series of long-standing issues, one of the most pressing of which is the lack of sufficient medical personnel in rural areas and smaller towns, a phenomenon known as ‘medical deserts.’ “I will commit myself to giving France the means to meet the many challenges ahead of us: combating medical deserts, addressing the ageing population, supporting our health institutions and professionals, implementing an ambitious prevention policy, and ensuring health sovereignty,” said the new minister upon taking office.
In a country where 67 percent of the population ends up giving up on making an appointment with a GP and the number of GPs in regular practice has fallen by 11 percent over the past ten years, medical desertification is at the top of Neuder’s list of priorities. To deal with it, he plans to pursue and expand incentives to bring healthcare professionals to under-serviced areas, as well as develop local health centres, coordinated practices and telemedicine.
Balancing Act
While the new minister may have ambitious goals and is set to present his strategy in the coming weeks, budget restraints are a pressing reality across all of the ministries within the new French government. With France’s public deficit having reached some 6.1 percent of the country’s gross domestic product (GDP) for 2024, the new government’s target is to reduce it to 5.4 percent of GDP in 2025. This means that drastic deficit-limiting measures will need to be taken, which will also apply to health. Neuder will have to find the right balance between cost-cutting measures and furthering policies.
As of yet, based on his input during the 2024 debates around the Social Security Financing Bill for 2025, we can gather that the incoming minister would prefer to create saving around sick leaves with one day of non-paid leave, rather than reduce the rate of reimbursement by the public social security system for doctor visits from the current 70 percent to the 65 percent proposed by the previous government. A preliminary vote on the Social Security Financing Bill will take place at the end of this month to decide if the currently proposed version of the bill will move forward.
Other challenges for Neuder will be resolving the status of the state medical aid known as Aide Médicale d’Etat for undocumented immigrants, something the right has been aiming to restrict, and “the end of life” bill, which provides active assistance in dying. In addition, he will have to confront the flu epidemic raging through France and the health challenges raised by the catastrophic passage of Cyclone Chido through the French overseas territory of Mayotte.
Staying Power?
After the previous government under Michel Barnier lasted less than 100 days, the question on many observers’ lips is whether or not the new Bayrou government and its ministers, including Neuder, will be able to endure and push policies through a hung parliament with no clear majority.
