Faced with the emergency, in spring 2020 the critical care units of French hospitals were able to hold out only at the cost of organizational improvisation and massive deprogramming. But such a situation is not viable and goes to the detriment of both patients and staff, points out the Court of Auditors in its annual report.
Critical care units: an organization that deserves to be rethought
Already experiencing strong activity before the arrival of Covid-19, from the spring of 2020, critical care units (or resuscitation units, as they are commonly called) were put to the test. With, at the end of the day, a mediocre result: at the height of the health crisis, only 20 intensive care beds per 100,000 inhabitants were available in France, against 33.9 beds per 100,000 inhabitants in Germany.
As revealed by the Court of Auditors in its annual report, this situation could have been avoided if these critical care units had been organized differently. First observation: in the French model, some of the critical care beds (namely 6,000 beds) are not placed under the responsibility of intensive care physicians, but mainly cardiologists or neurologists. If this choice to specialize in intensive care turns out to be interesting in normal times, it proved to be penalizing during the first wave of Covid-19 because these beds could not be mobilized for the care of Covid patients.
The pace of opening resuscitation beds does not keep pace with the aging of the population
Another organizational flaw: despite the aging of the population, new intensive care beds are not being opened at the same rate. According to the calculations of the Court of Auditors, if France had kept its 2013 “number of beds / population over 65” ratio, it would have had, at the start of the Covid crisis, 5,949 adult intensive care beds, against 5,080 recorded on January 1, 2020. In the next 20 years, the number of people over the age of 60 will increase by almost 5.2 million. It is therefore essential to open beds urgently.
Finally, the Court of Auditors welcomes the particular mode of financing to which the critical care units respond, namely a flat-rate remuneration and not only for the activity, a choice of common sense supposed to take into account the significant fixed costs inherent in these units. But this less dependence on activity-based pricing should be further developed because, despite everything, critical care units remain too dependent on activity-based pricing, which pushes them to maximize the occupancy rate (80 at 85% in normal times), calling into question the availability of beds in the event of a major crisis.