Territorial organization

Faced with the challenges of implementing a preventive and outpatient shift, our healthcare system has sought in recent years to structure a territorial organization of health policy. Several bodies and mechanisms have been created with this in mind : ARS, GHT, CPTS, CLS, DTS, PTS, ESP, etc.
In a country historically governed by a Jacobin state, still highly centralized today, the decentralization of public policies remains an often-expressed but rarely realized objective. In this regard, countries with a more pronounced tradition of political decentralization, such as Spain, Germany, or Italy, encounter fewer difficulties. Healthcare is no exception ; our experience has been marked more by a devolution of government to the regions than by true decentralization.
However, without seeking to fundamentally transform the organization of the state, it is possible to implement a truly national public health policy, implemented and managed at the territorial level. To successfully make this transition, it is essential to give an appropriate function to each existing system and to develop some of the pillars of the existing model, such as the Debré ordinances, which structured our system around the hospital and not the territory.
Pr Frédéric Bizard