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Health emergency: SAI France provides guidance

COUR DES COMPTES

In order to provide you with relevant information, the French Cour des comptes gives you the opportunity to read or reread its reports in relation to the current health emergency crisis or the situation of public finances.

Public Finances

Opinion of the High Council of Public Finance on the 2nd draft Amending Budget Act for 2020 (April 2020)
The Government has jointly referred the stability programme and a second draft amending finance law to the High Council. The exceptionally high level of uncertainty resulting from the health crisis caused by the Covid-19 epidemic is affecting all macroeconomic forecasts and makes it necessary to revise them frequently.

See also our previous reports on public finances:
The State Budget in 2019 (April 2020)
The implementation of the Social Security Act of 2019 (October 2019)
The Government Financial Situation and Outlook (June 2019)
The financial situation of social security in 2018 (June 2019)

Health

Public Assistance - Paris Hospitals (AP-HP) - Nursing staff (March 2019)
While the number of staff increased by 6.3%, AP-HP experienced a 14% increase in activity, particularly due to ambulatory care, as well as a worsening of the severity of the situations taken care of. Nurses' duties have increased as a result of several task transfer protocols. As a result, their workload has increased.

Hospital emergencies (February 2019)
Despite progress in terms of data collection and organization of services, emergencies are still overstretched, leading to frequent situations of tension within hospitals.

The vaccination policy (February 2018)
The Court found that there are still wide disparities between vaccines, in particular according to whether they are compulsory or simply recommended, territories and populations. These weaknesses, which can lead to the re-emergence of epidemics, are part of a context of growing reluctance to vaccinate, which is much more pronounced than elsewhere and is very widely relayed and fed by social networks.

Hospital debt (February 2018)
Following a new survey on this subject, the Court found uneven and fragile improvements in the control of debt risks in public health institutions. While a decrease in capital expenditure has been observed since 2014, its recovery is foreseeable, which calls for increased vigilance in investment choices.

The future of health insurance (November 2017)
Faced with the structural increase in expenditure, while the current regulatory tools have reached their limits, the quality and equality of access to care can only be maintained or strengthened by reforming the organisation and management of the health system.

Public Assistance - Paris Hospitals (AP-HP) - Governance and financial situation (October 2016)
The Île-de-France regional audit chamber recalls the difficulties encountered by the institution between 2010 and 2014, which resulted in the appointment of three successive managing directors at the head of the institution. While the reliability of the AP-HP's accounts has improved, further progress is still expected. The financial situation of AP-HP is improving, but it is mainly driven by revenues and asset disposals.

Preventing conflicts of interest in health expertise (March 2016)
Despite its ambition, the transparency system instituted by the law has major flaws (lack of control over the information declared, penal sanctions without any real scope, very restrictive interpretation of the advantages granted by manufacturers to health professionals). Verification of its implementation in five organisations highlights frequent irregularities.

The use of the funds mobilized to fight the A(H1N1)V influenza pandemic (March 2011)
Despite the existence since 2005 of a preparedness plan for an H5N1 influenza pandemic (known as "avian flu") based on WHO recommendations, the management of the A(H1N1)V pandemic cannot be considered totally satisfactory.

Public management

Management of funeral operations (February 2019)
The opening up of the funeral industry to competition has only partially achieved the objectives set by the legislator: although it has indeed brought about a significant change in this sector of activity, this development has benefited the operators more than the mourning families.

Education

Digital public service for education (July 2019)
The "educational digital public service" has been created to teach pupils digital techniques for their civic and professional integration, to improve pedagogy through the use of digital services and resources in the classroom, but also to promote equal opportunities. It also aimed to modernize the management of the educational service by facilitating relations between teachers, pupils and parents. The results of its implementation have been disappointing.

Housing

The contribution of housing policy to improving the employment situation (April 2020)
The labour market and the distribution of housing in the territory have undergone very different developments over the last fifty years, leading to a growing inadequacy. To overcome these difficulties, however, it is possible to use several housing assistance policy tools.

Implementation of the enforceable right to housing (March 2017)
The enforceable housing right procedure is complex, unevenly applied and inadequately regulated. Its scope is limited in areas where the housing situation is most difficult and the number of appeals is the highest.

Social housing and the challenge of access for low-income and disadvantaged groups (February 2017)
The findings of the Court and the Chambers of accounts joint work confirm the service provided by social housing to the community, but also reveal obstacles that reduce the effectiveness and coherence of this public policy.

Accommodating the Homeless (February 2017)
Public policy on emergency accommodation for the Homeless has made significant progress in the area of accommodation capacity and conditions of care. However, the impact of the economic crisis and the international context has not allowed sufficient adaptation to ever-increasing needs.