Occitania: 42 new scanners and MRIs to “end the logic of quotas”

Excessively long waiting times, geographical distance, inaccessible devices… insufficient equipment in the regional territory leads to a drop in care. The deal changes, it remains to apply.

“Any request that reaches the agency is viewed positively” : On September 29, during a press conference on the occasion of Pink October, breast cancer screening awareness month, Didier Jaffre, director of the regional health agency, addressed an informed audience that knows very well the difficulties in accessing magnetic resonance imaging and scanners in Occitania, subject to authorization by the ARS.

He insists : “I want to end the logic of quotas”. Joseph Pujol, director general of the regional cancer screening coordination center reacts immediately, delighted: “I have never heard such a speech.” Neither do users, who have been juggling online dating sites and unreachable or unresponsive direct numbers for years.

The situation is uneven in the regions, but the territory is generally under-equipped, and sometimes drastically so. The inventory prepared last June by the ARS gives a very complete picture of the situation. Two examples: Ariège is devastated in terms of equipment, with 13.1 scanners and 6.5 MRIs per million inhabitants, just behind Lot. The regional average figures are 20.2 and 16.9 respectively.

Still in Ariège, a third of the population is more than 45 minutes away from an MRI, it is one in two people in Gers. “90% of the population of Occitania lives in rural areas”insists Didier Jaffre. The problem : “If users are asked to travel tens of kilometers for an exam, they do not go, it is a factor of giving up attention“. These are however “tremendous means of prevention and diagnosis, particularly of cancer”.

Will things really change, why, how?

New state line and “transition phase”

“Decrees published fifteen days ago” set a new course of action, says Didier Jaffre. The reform of the image authorization law is underway. These texts will enter into force in June 2023, at the same time as the next regional health project is launched, currently in preparation, which will integrate these data: no more dogmas “So many scanners or resonances for so many inhabitants, we will not put quotas”, Didier Jaffre says, “We’re going too late”.

Meanwhile, for nine months, “We are in a transition phase”explains the ARS: “The authorizations of scanners and resonances are still subject to quotas by the current regional health project, legally I cannot grant more than what is authorized, but the idea is to say no to anyone, so I say yes, with a term: already valid new installations, under “exceptional needs”, to be effective in June 2023, start-up time, purchase of the machine, work… it takes six months to a year to install, I don’t want to lose time”.

Where will the new team be?

“There will be a scanner in Limoux, and maybe an MRI tomorrow”specifies Didier Jaffre, who emphasizes that“Another scanner has been requested in Aude”The “will say yes”.

Two additional MRIs in the batch, in Gourdon and Figeac, are also announced with certainty.

Without giving an exhaustive list, the ARS specifies that “Hérault, Aude, Pyrénées-Orientales and Gard” will also be served. In total, an additional 42 devices (24 scanners, 18 MRIs) will be authorized in the next nine months, “relying on local hospitals, territorial communities health professionals”and also through “new methods of cooperation between actors”in “shared medical imaging platforms” for instance.

Magnetic resonance imaging and scanner, for whom and for what?

Medical imaging is both a means of “prevention and diagnosis” and “treatment,” the ARS stresses. Why prescribe a CT scan and not an MRI, and vice versa? Both reviews provide complementary information. “The scanner is a radiological examination that uses X-rays and allows to reconstruct images of the body in two or three dimensions”, specifies the Health Insurance. It is contraindicated in pregnant women.

Nuclear magnetic resonance (NMR) “is an examination based on the use of electromagnetic fields” (not X-rays). It also gives “images of the body in two or three dimensions”. It is prescribed in particular to visualize the “soft tissues” (brain, spinal cord, muscles, viscera, tendons, etc.). To perform an MRI, the patient must not be in a medical environment that is sensitive to the magnetic field.

Public-private collaboration, medical demographics… the pitfalls

So are the weeks of waiting for an exam over? “We have to arrive within reasonable deadlines, excluding emergencies that have already been attended to. A month is too much. A week is fine”, estimates ARS. However, all obstacles have not yet been removed. To operate the devices, “we need radiologists and radiomanipulators”recalls Didier Jaffre. Medical demographics are at half-staff, but according to the ARS, “there are enough radiologists and radiomanipulators to operate new devices, we are not in tension…” as long as we add those of the public and the private.

“The counterpart” of this opening, he adds, “is that the public and the private work together, and respond to the obligation to ensure”, “a change of mentality and perhaps of paradigm”: “I ask that the actors carry out the projects jointly and ensure the permanence of care, That doesn’t mean all devices have to work 24 hours a day. He is not worried: “It is the quota policy that induces competition”.

On the other hand, the investment (€700,000 for a scanner, €1 million for an MRI) should not be an obstacle. : “It is the assumption of the acts by the Health insurance that ensures financing, it is a virtuous circle. And most of the devices today are bought in leasing, for more than seven years, the rent is with maintenance”.

One unknown remains: “There are some supply difficulties. We are attentive to the deadlines being fast”.

In the inventory drawn up last June, the report on the regional health plan for the years 2018-2022 showed that as of May 31, 19 authorized devices, 11 MRIs (one in Gard, two in Haute -Garonne, one in Gers, three in Hérault, one in Pyrénées-Orientales, two in Tarn, one in Tarn-et-Garonne) and 8 scanners (one in Aude, four in Gard, two in Haute-Garonne, one in Gers ).

Jean-Michel Bruel, user representative: “Abnormal delays”

Vice President of France Assos Santé Occitanie, which represents users, Jean-Michel Bruel is also the former head of the radiology department of the Saint-Eloi hospital at Montpellier University Hospital. He participated in discussions with the regional health agency. He welcomes the new policy and hopes for a “materialization” because “the population’s demand is legitimate.” But there is so much to do… “There is no logical path of care. Apart from the scarcity of resources in scanners and MRIs, there is a coordination problem. There are too many patients who leave their doctor with a prescription for an exam, and who have a bad time, because if it is not the prescribing doctor who does the paperwork, the appointment is obtained in abnormal delays, “says the user representative.

For Jean-Michel Bruel, we should also start implanting scanners “everywhere there is surgery”. An example: “It is not normal that the Causse clinic, in Béziers, has run out of a scanner, the request has just been validated”.

“This development is a good thing,” he concludes, while recalling “why we have come to this”: “We could make the analogy with the numerus clausus, political reasoning has long said that if we reduce the resource, we also reduced demand “. According to him, “we should greatly improve the current situation” but “we will not solve all the problems, because a problem of medical demography is coming.”

Sophie Aufort, radiologist: “We have to mesh the territory”

Sophie Aufort, a radiologist at the Clinique du Parc, in Castelnau-le-Lez, represents radiologists in the regional union of health professionals (URPS).

Do you agree with the idea of ​​releasing the installation of scanners and MRIs in the territory?

With my colleague Professor Jean-Michel Bartoli, from the AP-HM, in Marseille, I participated in the discussions in the ministry on the subject. We had not worked with the idea of ​​”letting go” of the installation of heavy material equipment (EML), but with the need to reform and integrate interventional radiology in the care process. In the end, this is progress. Authorization below three EMLs per geographic site will no longer be required. And it is very good news that the regional health agency wants to work very quickly on the issue. This is unheard of after years of discussions where I had to choose between two sites that had just as many needs as the other.

Is our region really poorly equipped?

We remain out of step with the national and European average, which translates into long waiting times. But many efforts were made during the revision of the last regional health project, halfway through its completion. Devices have been authorized, but surprisingly they have not yet been installed, often to the public, due to a question of financing.

We should already have a scanner and an MRI in all hospitals and clinics.

Public/private collaboration, do you believe in it?

There are things that work, and it is very interesting in philosophy. I understand that this is the desire of the ARS. But there are many uncertainties and unknowns, it is a real concern, with implementation difficulties, which arise, for example, in isolated territories, far from health facilities, where private radiology practices have also closed. We had a project in the Pyrénées-Orientales, to install a scanner near a nursing home, as part of a territorial professional health community (CPTS), so that the population would have access to this equipment. The idea did not have a crazy reception… We also had the idea of ​​offering a scanner in La Paillade, in Montpellier, near a multiprofessional health center, because in the neighborhood there are people who will not take care of themselves. It is not about the geographical distance of the team, in this case. This is the problem of a population away from care.

No medical demographics problem?

There should be no angelism. Today is the hunt for radio tampering.

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