It is sadly, but not surprisingly, that we learned that the litigation section of the Council of State, 10th and 9th chambers combined, rejected the request of the company Sebdo (the operating company of the weekly newspaper Le Point) allowing him to access the anonymized database of hospital stays, known as the “PMSI base” (project for the medicalization of information systems), a concept and database that I created in 1983. Sebdo was access between 2001 and 2020, which enabled it to produce, each year, a long-awaited ranking of French hospital services.

Since then, a new actor has appeared: the Cesrees (Ethical and Scientific Committee for research, studies and evaluations in the field of health) – excuse me – which, by decree, decides on the methodology for processing this data. , as on “the character of public interest” of the analyzes envisaged. The Cesrees considered that the methodology of these treatments was questionable and that they were “devoid of public interest”, opinion followed by the National Commission for Computing and Liberties (Cnil) and therefore the Council of State.

It is interesting to note that this judgment of the Council comes from the 9th chamber (energy and taxation) and the 10th (public freedoms) and not from the 5th (hospitals) or the 1st chamber (health). As for the public rapporteur and the auditor who prepared this judgement, their training is strictly legal, even if the auditor can take advantage of an internship at the Directorate General for Health of the European Commission. This makes it possible to understand certain errors in the recitals of the judgment, not to excuse them.

It would have taken another knowledge of the hospital sector and the methodology of public health research to override the opinion of the CNIL which, it is true, is still chaired by an eminent member of the Council of State. Sebdo’s chances were slim. In addition, if we can understand that the role of the press has to do with civil liberties and that the 10th chamber is from this point of view legitimate, the tax aspect of this appeal and therefore the jurisdiction of the 9th chamber escapes us .

Without repeating here the details of an article published in these columns when the unfavorable opinion of the Cnil fell, let us underline that the Council of State takes on its account two very questionable points of view of Cesrees. The first consists in calling into question the fact that the rate of intervention (most often surgical) on an outpatient basis – and not in conventional hospitalization – is a sign of the quality of hospital organization.

“…[T]he correlation established between the length of stay and the outpatient intervention rate, on the one hand, and the quality of the organization of the service, on the other hand, does not take into account the structure of the establishment’s activity and, in particular, the nature and seriousness of the pathologies taken care of, which nevertheless largely condition the length of the stay. The methodology adopted is, on these two points, affected by biases likely to influence the results of the classification and to alter the quality of the information delivered to the public. »

In the position of Cesrees, taken up by the Council of State, we therefore find a rearguard fight of French surgeons, well represented in this committee. Indeed, it will have taken forty years for public hospital surgeons to finally accept this type of practice, beneficial both for the patient (hospitals are dangerous places, it is good not to stay there for long) and for health insurance. (the cost for the same operation is half as much), but it is true that the surgery department is no longer totally free in its planning.

The second criticism consists in considering that, when patients change department to seek treatment, this indicator would be unsuitable for measuring the reputation of a service. “On the other hand, the measurement of “awareness” is carried out on the sole basis of the percentage of patients treated in an establishment located in a department distinct from that of their domicile, without taking into account the distance between the latter and the place of residence. nearest establishment meeting the needs of patients and, in particular, situations in which the establishment closest to the patient’s home is located in a neighboring department. »

Admittedly, this is a somewhat rough measure, but the Point team has always tried to do the best with the data available. If the members of Cesrees had had a scientific approach, and not small-footed judges in the name of an alleged “ethics”, they would have suggested other ranking criteria because, contrary to what the Council of State, science is not a matter of status but of method and that of Le Point is, contrary to the manifest contempt for the press revealed by this judgment.

“The ‘hospitals and clinics ranking’ published each year since 2001 in the weekly Le Point does not constitute a scientific publication issued by a research organization or a public authority, but processing for journalistic purposes established by a press organization aimed at the readers of the magazine it distributes, in order to inform them about the quality of the care provided by health establishments and to enlighten them on their comparative merits accessible. »

It will indeed have escaped no one that Le Point is neither a research organization nor a public authority, but it is totally false to claim that “the methodological choices of Sebdo are not supported by scientific literature” and that it would follow that this work is not scientific. I could cite dozens of articles using one or other of these variables, which is moreover the reason why certain insurance organizations used this classification, which, paradoxically, is criticized by the Council of ‘State. Yes, good rankings do have a purpose!

Of course, the method used by the Point teams is not perfect. The true measure of the quality of care of a hospital team such as, for example, the one-year, three-year, five-year survival of patients in a department suffering from this or that pathology is not always measured and when it the east, the data is not published and therefore not accessible by the press. Similarly, Health Insurance has information that it does not use or publish so as not to anger the powerful corporation.

I find, in these corporatist fights, the same conflicts as forty years ago when we were able, thanks to the PMSI, to begin to know precisely the medical activity of each service (until then we only had the rate of occupancy and average length of stay) while this method has since been around the world and is the basis of hospital pricing in countries around the world. Forty years ago, the corporation, and in particular the teams of the AP-HP, already put all its weight in the balance to prevent third parties from simply evaluating their activity. Today it is about the press and its freedom; nothing less.

The Point gave information to those who do not know it. This classification was also carefully kept by health professionals because they thought, like me, that it was quite fair, imprecise certainly, but fair. It is regrettable that the Council of State did not want to detect that in the name of an alleged ethic (which one by the way?), it was defending the most obvious of corporatisms and in doing so called into question the freedom of the press. who tried rigorously to inform the French. Yes, hospital services are not equal and information can be, for some of our fellow citizens, what separates life from premature death.