“patients flee to other establishments”

The Regional Chamber carried out an in-depth audit of the accounts and management of the Ariège Couserans Hospital Center (CHAC) for the 2017 and following financial years. This control covered various aspects, including the provision of care, activity, governance, strategy, reliability of accounts and the financial situation of the establishment.

Inadequate care provision

CHAC, located in an isolated rural region, serves a population of more than 30,000 residents, the majority of whom are aging. The establishment offers varied services such as psychiatry, medicine, surgery, obstetrics, geriatrics and rehabilitation care. However, it faces some of the lowest rates of use of hospital care in the Occitanie region. Despite the lack of direct competition, patients flee to other facilities, resulting in costly underactivity.

The hospital has tried to maintain a broad range of care, but this seems incompatible with a necessary strategic reorientation to meet the specific needs of the population. Bed occupancy rates remain modest, below national standards, and facilities, particularly operating theaters, are underutilized. In 2022, CHAC recorded an average of just over one birth per month, a significant decrease compared to 2022, when 160 births took place. In surgery, the two active operating rooms only recorded an occupancy rate of 76%, well below the recommended 85%.

In addition, the establishment does not seem to have developed opportunities in key areas such as geriatrics and psychiatry, which are nevertheless vital for its patients. Psychiatry, although CHAC's main activity, has not been adequately integrated into the establishment's overall strategy.

A worrying financial situation

CHAC's current strategy appears not only unsustainable, but also financially critical. The establishment faces a lack of working capital, making it impossible to pay its tax and social security debts within the allotted time frame. Revenue, already low due to insufficient activity, is also impacted by the quality of coding of procedures and invoicing.

Over the last four years, psychiatry has generated more than 10.5 million euros in surpluses, financing loss-making activities, notably general hospitalization and obstetrics. Despite increased support from the Regional Health Agency (ARS), the apparent deficit exceeded 20 million euros in 2022. However, this figure could be underestimated due to incorrect depreciation of assets and a lack of provisions.

Need for strategic thinking

Faced with this situation, it is imperative that CHAC rethink its strategic model based on the real needs of its population. The option of a regional hospital group could have facilitated better structuring of the healthcare offering, but this was not achieved. The current governance arrangements have not favored this reflection, the establishment having been unstructured for several years. A potential merger between CHAC and CHIVA could constitute a viable solution, making it possible to create a single departmental hospital establishment. This merger, accompanied by collaboration with other establishments such as those of Ax-les-Thermes and Tarascon-sur-Ariège, could make it possible to structure a care offer more adapted to the needs of the region's inhabitants.

The Ariège Couserans Hospital Center is at a crucial turning point. The challenges he faces, both in terms of healthcare provision and financial situation, require immediate and thoughtful action. A strategic repositioning and a possible merger with other establishments could offer a solution to guarantee the sustainability of the hospital and improve the quality of care offered to the population.