PRESS RELEASE

12/10/2023

Public thematic report

THE FINANCIAL POSITION OF PUBLIC HOSPITALS

AFTER THE HEALTH CRISIS

On the eve of the covid-19 epidemic, the overall financial position of public hospitals

appeared to be deteriorating, with recurring losses (€558 million in 2019). Two investment

plans, Hôpital 2007 and Hôpital 2012, had led to a tripling of financial debt to €30 billion in

2019. The interest burden of the debt and the declining profitability of the operating cycle

had put a strain on their ability to finance new investments. To avoid a spiral of excessive

debt, public hospitals have underinvested over the past ten years, which has led to their

buildings and equipment becoming increasingly outdated.

Exceptional, uncontrolled aid improves hospitals’ financial position

Paradoxically, the financial position of hospitals improved during the health crisis, thanks to the

exceptional aid arrangements put in place. The additional costs of treating patients affected by

covid-19 were covered by the national health insurance scheme (€3 billion allocated in 2020,

€3.2 billion in 2021 and €0.7 billion in 2022). A financing guarantee compensated for the loss

of revenue suffered by hospitals as a result of the fall in activity, in particular the cancellation of

surgical operations (€2.5 billion in 2020, €1.6 billion in 2021 and €1.8 billion in 2022). New

resources were allocated to healthcare establishments in return for salary increases granted

under the Ségur healthcare agreements signed on 13 July 2020 (cumulatively, €1.1 billion in

2020, €5.8 billion in 2021, €7.2 billion in 2022 and €7.6 billion forecast for 2023). As a result,

the resources of public hospitals increased overall, in line with their costs. However, the

exceptional aid granted during the health crisis was not properly managed or monitored.

Growing distortions in the financial model of public hospitals

However, by 2022, public hospitals had not returned to their pre-health crisis level of activity

(- 1.7 % of stays excluding sessions compared with 2019), due to some patients forgoing care,

increased competition from the private sector and the effects of a shortage of nursing staff.

The nature of hospital activity also changed, with continued growth in outpatient care, which

allows patient treatment paths to be arranged during the day.

Human resources have become a major concern. Despite a 2.7 % increase in the number of

salaried staff in the public hospital sector between 2018 and 2021, operating difficulties have

increased due to recruitment constraints, a rise in absenteeism and the strain placed on staff

by night and weekend shifts.

From a financial perspective, the reduction in actual patient capacity in many hospitals is

putting pressure on their operating revenues and on their ability to cover fixed costs. Against

this backdrop, the conditions for the long-term equilibrium of the operating cycle of public