“A real health prevention policy cannot exempt itself from questioning fee-for-service payment”

FAs with the human tragedies and the abysmal expenses generated by the seemingly inexorable increase in the prevalence of cancers and other chronic diseases, our healthcare system has clearly reached its limits, both in terms of its effectiveness and that of its financing. . The time seems to have come to give prevention the central place that simple common sense would have always wanted it to occupy in our health system.

From the field of good intentions and political speeches, prevention must now take the place that should always have been its own: that of the pillar of our health policy. We no longer have the means to do otherwise! The government has elevated health prevention to the rank of national priority; Parliament and health institutions have made this issue the priority focus of their work and reform projects.

However, despite considerable progress in diagnostic means and digital technologies, and because it combines factors as heterogeneous as education, diet, hygiene, lifestyles, environment, or even geographical location, health prevention remains infinitely more complicated to organize and implement than a healthcare system.

A normative system does not have a preventive approach

The task is therefore difficult. It even seems, in a context of deterioration of medical demographics and difficulties in meeting the demand for care in many territories, insurmountable. Our conception of progress from the Enlightenment has favored an overly mechanistic vision of man, ousting the patient from clinical practice in favor of replacement by the study of his organs, then his cells and now his genetics.

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The resulting modern organization of medicine is based both on statistics (evidence-based medicine) and on the medical procedure. The latter is codified in protocols issued by learned societies, then in nomenclatures defined by Health Insurance. This standardized approach “manages” the disease based on an interpretation of symptoms by isolating them from the context of their appearance, and ignoring the singularity of each individual. We no longer treat the man… but the disease.

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This normative system is of course perfectly incompatible with a preventive approach which requires a vision of humans in their entirety, their singularity and their environment, in order to identify and act preventively on common risk factors for the occurrence of illness or accident. To be effective, medicine can no longer resolve itself to simple one-off curative acts disconnected from the complex reality of the patient. And this, especially since health professionals are the first to want to find time to better do a profession that most of them chose by vocation.

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