Land “closed data”: this is what a Théodule Committee has just invented, issued by the Ministries of Health and Research, with the collaboration of the CNIL (National Commission on Information Technology and Freedom), prohibiting the Point access to the Information Systems Medicalization Program (PMSI), the heart of the annual list of hospitals and clinics. From organ transplants to the smallest gallbladder surgery in the country, this gigantic database contains anonymous records of the 28 million patients hospitalized each year. An essential tool for deciphering the activity, good or bad, of public and private healthcare facilities.
We owe this veto to an obscure “independent” body – but whose members are appointed by the two ministers – the Ethical and Scientific Committee for Research, Studies and Evaluations in the Health Field (Cesrees). He doesn’t like some criteria of our ranking, Cesrees believes his results “Risk of misleading patients” and therefore that this investigation “has no public interest”. Of cheating. This did not prevent the CNIL, also supposedly independent, from immediately sharing this opinion in a decision sent to the Point on 4 November when, for more than twenty years, it had consistently issued favorable authorisations. And he noted in his decisions the purpose of the public interest of the schedule. All of this, in reality, has a bad name: that of censorship. It should be remembered that the law of July 29, 1881, which protects freedom of the press in France, provides that “Any newspaper or periodical may be published without prior permission.” In short, we can be sued – which has never happened for the hospital ranking -, disagree, send us the right to reply, but not prevent us from working.
We suspect that the criticism of our methodology is just a pretext. In reality, it is a question of bringing to their knees those journalists who dare to say that not all health facilities are of equal quality and indicate those where it is better to be treated. A crime of comparison for all the apparatchiks of the system sitting on their piles of data, which it is not a question of using to enlighten the patients, who nonetheless finance the entire system. Without forgetting that, for the censors, health information, through their networks, will always be accessible without too much effort. This is not the case with most French people. “The main source of information on the offer of treatments remains ‘word of mouth’, the limits of which are due to the information asymmetry between patients, depending on whether they have more or less easy access to healthcare professionals”, observed the Council of State in 2018, in its report on the rules applicable to information and advertising in the health field. And to continue: “These factors explain why, according to a recent study, 35% of people under 35 and 26% of all those who could be assisted would give up the care they need because they don’t know where to turn. or how to navigate. » But informing would mean acknowledging that not all medical care is created equal. “The French don’t love freedom, only equality is their idol”wrote Chateaubriand. It is therefore very frowned upon to carry out an annual diagnosis of hospitals, even if it is a question of summoning only the best.
Anonymous records. This isn’t the first time a government has attempted to block access to this information. Since the first revelations obtained by the PMSI, in 1998, Martine Aubry, then Minister of Health, had tried. The CNIL then had to give her opinion, which would follow an authorization from the minister – in the face of the outcry, this last point was cancelled. Another attempt: conjuring a database loophole to prevent us from accessing it. After incredible scenarios, it would have been possible, according to some researchers, to identify a person from these computer files, however anonymous. But one of these scientists, Dominique Blum, will explain the origin of the maneuver on his blog: “It must be said that the ministry despised journalists who published rankings based on the PMSI, and its vigilance knew how to shoot any wood, using both the CNIL and statistical work if necessary. » However, all these apocalyptic risks have not prevented the services of the Minister of Health from sending us, every year, by simple post, CD-ROMs containing the data of millions of hospitalized patients, in spite of all safety regulations.
Silence above. The noose is tightened with, in 2015, the law brought by the Minister of Health Marisol Touraine which, in its article 47, establishes a first preventive control committee on access to data. “With this law, goodbye to original investigations that rock the system by bringing disturbing information to the public’s attentionwe predicted then. Like hospital mortality, which varies so much from one establishment to another, or the hyperactivity of certain doctors who make a killing. » Interviewed by the Association of Social Information Journalists (Ajis), the Minister had calmed spirits by declaring, on 31 March 2015 at the National Assembly: “The journalists who have been using hospital data for fifteen years, I am thinking for example of those who draw up hospital rankings, have demonstrated their professionalism and their responsibility. They will be able to continue to have access to it, just as researchers or patient associations will be able to access it. » We would have liked the current Minister of Health to confirm the words of his predecessor. Today François Braun no longer answersS. However, the Minister has confessed in the past that he awaits the annual publication of the list of hospitals and clinics like his hospital doctor colleagues, allt as hungry for information as the general public. But the former emergency room doctor did not react to our calls to discuss the ban on access decided by his services and by the CNIL. There is also silence at the Health Data Hub, a vast warehouse of French health data created in 2019 as part of the “start-up nation” dear to Emmanuel Macron, and which provides the secretariat of Cesrees. Finally, we are not talkative to France Assos Santé either, which in any case claims to be the spokesperson for users. Its representatives must have been stricken with Stockholm Syndrome from frequenting the fine shovels of our healthcare system. “The classification of Point it is a national reference popular with readers and the Frenchreacts Jean de Kervasdoué, health economist, who was director of hospitals and regularly contributes to the columns of the Point. Doctors keep it and consult it. The so-called methodological purity of Cesrees’ opinion is just another example of the medical corporatism which claims that all prescriptions are good and all treatments are of quality. » Our readers know this, we won’t let it go. We will launch the most appropriate legal remedies against this complaint. And we will continue to investigate the hospital, because information is the first condition of equal care.
First published in 1998 in the columns of the magazine Science and the futurethen in those of Figaro Magazinein which the annual list of hospitals and clinics appears the Point in 2001 ; since then, it has not ceased to be acclaimed by our readers and many professionals. To do this, two journalists and a computer scientist process the digital data of the PMSI (Program for the medicalization of information systems) for six months, a database containing the anonymised records of the 28 million patients hospitalized each year in the public and private sectors. Added to this are the answers to a questionnaire in which 281 items are addressed. The latest ranking, published in 2021, examined 1,400 healthcare facilities, across 84 medical-surgical specialties and 132 rankings§
XOSE BOUZAS/Hans Lucas via AFP – Bruno DELESSARD/Challenges-REA – Youtube screenshot/Dhagpo Bordeaux – Youtube screenshot/Epsaa digital Mooc