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Administration and Management

The evil effects of the present system of planning of heavy equipment in imaging (carte sanitaire) is known. The «Etienne» report or the report of the Xth Plan, among others stress them sufficiently. Let us cite, for example, the arbitrary selection of equipment listed «heavy», the lack of criteria in needs, the inadequacy of the procedure in innovation, the heaviness of centralisation. The absence of follow-up in the activity aggravated the situation. The program of medicalisation of the systems of information PMSI derived from the North American «Diagnostic related groups», proceeds with difficulty. Even in the United States of America, their development seems to be stagnating because of the increase in interferences (creation of ambulatory diagnostic centers in the vicinity of the hospitals during the months following a DRG plan, exclusion of the practitioners concerned from the decision ... ). The situation appears blocked. Everyone regrets the absence of a tool of evaluation, all the while criticising the PMSI and making the «global budget without PMSI» responsible for all the wrongs. The global budget is accused of transfering of activity from hospital to private practice (pre-operatory check-ups and follow-ups), forgetting the essential parameter of modern imaging which is that of the comfort of ambulatory medicine. The example of the X-ray scanner is often given, since the latest one is rich in information. Innovative equipment at the origins of the first «imaging» impact in the 1970's, the X-ray scan has become a banal investigation. It replaces the «remote-control» X-ray table of conventional radiology. Its only criterium of efficiency is quantitative and topographic (number of examinations per day and per hour, anatomical regions ... ), and having no reference whatsoever to therapeutical and epidemiological efficiency. France is ranked 9th in Europe for equipment per one million inhabitants) with her 405 X-ray scanners, and only 12th in the world (one machine for 138,000 inhabitants). And yet, signs of saturation appear in certain regions: subemployment of the machines, feeble number of requests ... One can imagine, as a consequence, that the extension of installations should not actually really increase the number of machines. But this is something which must be proven: and reveals the experimental nature of the aforementioned proposal.