For the State, financialization goes well with ethics

Commanded in July 2024 by, among other things, the Ministry of Health as well as the Ministry of the Economy, the Report of the General Inspectorate of Finance (IGF) on “Causes and the effects of the financialization of the health system” concludes that the financialization of the health system is not necessarily a bad thing, both from a macro-economic and ethical point of view. Furthermore, The authors of this report initially endeavor to establish a genealogy of the participation of financial actors in the. Therefore, health system. However, This participation can take the form of the sale of real estate assets. Nevertheless, use of investment capital or even recourse to financial debt.

Financial actors – State, financialization goes well ethics

Financial actors likely to invest in the health system may be:

• medium-term actors, such state, financialization goes well ethics as investment capital funds;
• medium -term actors, such as real estate investment funds;
• Long or very long -term actors, such as pension funds or sovereign funds.

By typology. Nevertheless, “In the private clinics sector, investment capital funds have a majority share of the capital of 3 of the 4 main groups: 60 % of the capital of Almaviva, 68 % of the capital of Vivalto and 95 % of the capital of Elsan”. For example, In the sector of medical biology laboratories. Therefore, “The capital of the biogroup and ino groups are mainly held by the biologists working (respectively 98 % and 81 %); The capital of the Cerba Healthcare, Synlab and Unilabs groups are mainly held by financial actors; The Eurofins-Biomnis group is held by another industrial player, Eurofins Scientific ”. Furthermore, In the state, financialization goes well ethics radiology sector. Moreover, “A minority of actors is at this stage concerned by the presence of financial actors in its capital”.

Marginal investment – State, financialization goes well ethics

For actors in the investment capital. the care sector remains marginal, representing only 3 % of the total volume of investments made in France, against 25 % in digital, for example. What is more. volumes invested have been down sharply for 2 years: 457 million euros in 2023 against 1,677 million in 2022, a decrease of 72 % in one year.

Four diagrams

In addition, there are, in the health sector, 4 investment patterns:

• “The model of private for -lucrative clinics;
• the salt model (liberal practice company);
• the model of health centers;
• The groups of pharmacies, close in some ways to the model of health state, financialization goes well ethics centers ”.

Groups of private clinics are commercial companies where health establishments are considered 100 %subsidiaries. Health professionals exercise in a liberal way within the framework of a liberal exercise agreement (CEL). In salt, professionals exercising there hold 50 % of the capital, while non -professional third parties can hold 25 %. In theory. health professionals who exercise in salt master current management, but in practice “A legal system implemented at a time when investors intervene in capital always regulates the conditions for the management of salt and define the rights of the minority financial investor”. Health centers have an associative or mutualist status. A private group can create associative health centers. then provide them with a series of services (management, IT, HR), which allows the group to pay themselves. Doctors in health centers are salaried, as are paramedical and administrative staff.

In state, financialization goes well ethics pharmacies, “Investors take holdings in the capital of pharmacies groups to which the pharmacies adhere. These groups. which mainly play a role of service providers for pharmacies, do not have a direct capital link with them, but a contractual link, via the provision of services ”.

Independence. quality of care

Whatever form taken by these investments, health professionals “Fear that the intervention of these actors will end up being at a high cost for the community, to the detriment of quality and access to care, as well as the ability of health professionals to exercise independently”. However. the mission considers that a withdrawal of these investments, massifs in the sector of clinics or medical biology laboratories, could jeopardize entire sectors of care. Also. the authors of the report consider “That it would not be appropriate for the state, financialization goes well ethics financing of investments or effective for the protection of the independence of professionals and the quality of the care offer, to seek to regulate the intervention of financial players by limiting the possibilities of equity contributions”. On the other hand. the mission advocates “Clarification and strengthening of the effectiveness of the rules of governance of exercise structures and the ethical framework”. This is materialized by the development of a “Doctrine for the use of salt governance rules”. “A strengthening of transparency obligations with regard to professional orders”as well as a “Work to renovate ethics codes”.