Mdoctor and public health inspector, retired, I have devoted my career to the service of the State in the field of public health and inspection since 1982. I was for a time director of health and social affairs, for a time colleague of the Prime Minister, who performed the same functions in the department of Var.
In addition to being a clinician, I am a specialist in geriatrics and geriatric cardiology. And, back on technical missions, from the beginning of the 2000s, I was able to measure the drift from a sovereign mission towards a managerial function of the territorial administration of the State. It always seemed to me that cases based, in part, on a lack of State supervision, could only happen.
Indeed, if the regional health agencies (ARS) are the subject of strong criticism, it should not be forgotten that they are only the heirs of an administration which has lost its sovereign mission, which is very significant in the 1970-1990, for the benefit of a regulatory mission.
This movement concerned the departmental and regional directorates of health and social affairs (DRASS-DDASS), then the regional hospitalization agencies (ARH) from the 1990s. The greater autonomy given to establishments, new pricing methods have changed the nature of the relationship between the establishments or services and the administration. Initially qualified by the latter as establishments, these have become operators and then partners under the benevolent acceptance of the major hospital or medico-social federations.
Change of profile and practice
The professional bodies that have accompanied the recent history of the territorial administration of the State have clearly changed their profile and practice, both against their will, but also through a loss of motivation for more action on the ground. burdensome and more risky.
Significant was the request of the union of medical health inspectors, during the revision of their status in the 1990s, for the term medical inspector to be abolished in favor of public health doctor, the ministry conceding the term medical inspector of public health. Similarly, the term inspector of health and social affairs was replaced by the term inspector of health and social action.
Also significant is the disappearance, within the ARS, of the terms inspector, medical inspector or medical adviser (from health insurance), in favor of the terms technical adviser or project manager.
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