Les centres de santé : une histoire, un avenir

Abstract

Health houses and health centers are often hailed as specifically modern forms of medical practice in mobile healthcare provision. Yet the concept of health center emerged in the seventeenth century. The founding principles of these institutions were to promote access to good-quality universal healthcare and to practice a form of healthcare that treated patients in their globality (i.e. within their social and environmental context) based on public healthcare measures. Though they constitute a response to a specific healthcare project, healthcare centers face a number of specific difficulties that pose a challenge to their durability and development. Payment per consultation is ill-adapted to the remuneration of their services, and methods of remuneration that may be applicable to independent medical practitioners do not apply in the context of health centers, which may struggle to survive without the support of territorial collectivities (i.e. regional and local authorities) or associations. Health houses face similar difficulties in terms of their structural expenses. Expectations are high for trying out new methods of remuneration. The perspective and experience of healthcare centers will likely prove to be essential in this context. Their future needs to be envisaged alongside health houses and medical hubs. The growth of precarity and the increasing difficulties affecting access to healthcare provision need to be taken into account. The choice of the specific type of structure will depend on local realities, on the political will of regional authorities and on the specific projects of healthcare professionals. Yet whatever solution is envisaged, it will not be possible without public funding.

Les motivations des médecins généralistes en centres de santé. Enquête par entretiens

“…Les Centres de santé (CDS) en France, héritiers des dispensaires du début du xx e siècle, se sont depuis écartés de ce modèle, tout en conservant un souci de réduction des inégalités d'accès aux soins [1,2]. Les CDS sont, par définition légale, des structures sanitaires de proximité dispensant principalement des soins de premier recours.…”