The threat rumbles. The liberal general practitioners were not able to bend the Health Insurance during the negotiations on the price of the basic consultation that they want to bring to 50 euros instead of the current 25.
The categorical refusal of the administration proposing a revaluation to 26.50 euros has angered many practitioners.
And this anger begins to take on significant proportions. Many of them, in particular represented by the union UFMLS (French Union for Free Medicine), have been agitating for a few weeks the threat of a collective disagreement to break the government. What would be the consequences of taking action?
• What is agreement/disagreement?
This is the “medical agreement” that links doctors to health insurance. It is a kind of contract that covers administrative processes in particular, sets the reference rates that serve as the basis for reimbursements (such as the price of a general practitioner consultation at 25 euros throughout the territory, which is called Sector I). , and reimbursement procedures.
The doctor who chooses to disagree breaks this contract. Then he is free to set his rates, he no longer has to report to the Health Insurance and therefore goes to Sector III. In addition to a revaluation of the consultation, the supporters of the disconvention highlight a saving of time (less administrative tasks) for the benefit of care and a greater attractiveness for young doctors.
Today, according to figures from the Health Insurance at the end of 2021 cited by the parisian, there are only 572 non-conventional general practitioners against 111,381 contracted general practitioners and specialists. Most are specialists.
In addition to the question of the rate, what is being denounced is the agreement as a whole.
“This system is at the end of its life. The doctors are exhausted and we are being asked to do more and more when we are already at 55 hours a week. It is not possible, how to attract young doctors with this? explains to BFM Business, Jérôme Marty, general practitioner and Secretary General of UFMLS.
“We have the impression that they are not interested in developing liberal medicine, where are the attractive conditions? What we want? Generalize health centers managed by pension funds? We don’t want it. .
The threat of a massive non-convention is regularly raised by professionals during negotiations with the Health Insurance. But the tickets to the act are scarce because in the end the risk of losing a large part of their clients, frightened by a poorly reimbursed consultation at 50 euros, is important.
But against a backdrop of runaway inflation and growing discontent, many professionals say they are ready to cross the Rubicon. Collectively.
YO’UFMLS intends to accelerate and concretize this movement. To crystallize this complaint, she organized at the beginning of March in Paris of the “assizes of disconvention” where 700 doctors were present in person and a thousand online. Objective, encourage them to leave the collective agreement to accentuate the balance of power with Health Insurance.
“It is with fervor and enthusiasm, and in conscience, that hundreds of them have completed the launch of the collective objection by depositing their letters of intent to objection under the observation of the judicial officer who will maintain those -ci throughout this operation. ” underlines the union in a press release.
On his site, you can also find a letter of intent kit for professionals who want to get out of the way. And a counter indicating the number of doctors who have presented this type of letter.
“Actually, 544 have been presented and we have more than 400 pending”, explains Jérôme Marty. “When we are between 15,000 and 20,000, we are going to go to the government and it will no longer depend on us. If the agreement is upheld, we take action. Some want to leave now, but the idea is to weigh in a period of 14 to 18 months. But it’s a real swell. The State must take this into account, but it is looking the other way.”
For the patient, the difference is very important since the reimbursement of their consultation by Social Security will be minimal: 0.61 euros compared to 70% of the agreed rate. The rest may be covered by your mutual according to the guarantees of your contract.
Therefore, the choice will be difficult. You agree to pay (much more) or change your treating doctor, which can be complicated in the context of a shortage of local doctors in certain areas of the territory. Therefore, this would directly penalize the poorest patients.
For the Minister of Health, François Brun, the disagreement “would further penalize the French by creating a two-speed medicine”, he estimated in France Inter on February 27.
Thomas Fatôme, general director of Cnam (National Health Insurance Fund) does not like this initiative either. “It is completely irresponsible to ask for this type of behavior. We consider ourselves partners of doctors, we want to build better access to care with private doctors,” he said on February 27 on France 5.
An attack swept away by the UFMLS. “On the contrary, we want to be able to change the mode of reimbursement of Sector III, or even create a new sector, and therefore better reimburse patients”, explains Jérôme Marty.
As? “The authority fee (0.61 euros, Editor’s Note) is based on outdated jurisprudence. Therefore, we will present a priority question of constitutionality and the Secu will lose. Pending this decision, we are putting everything in motion To reach the end, we are accumulating the letters of intent, we are setting up a new reimbursement mechanism and we will be ready in 14 to 18 months when the decision is made”, explains the Secretary General.
The union’s objective is thus to have a favorable decision from the Constitutional Council and implement a new coverage framework to get out of the problem of the minimum reimbursement currently in force.
• Are all doctors on the same wavelength?
Not really. If the main professional union, MG France, also opposes the convention proposals proposed by Health Insurance, it rejects the idea of collective disagreement.
“It’s a stupid measure,” says Jean-Christophe Nogrette, secretary general. The result would be “a drop out of the poorest patients”, he explains to BFM Business. Attacking the contract is attacking “the pillar of health in France and it is putting the private in the place of solidarity. It is a real danger.”
The doctor said he was concerned about the turn of events. “The exasperation is such that anything can happen. Organized courts on this issue, we have never seen that, so it would not be surprising if this led to decisions of disagreement, which arouses concern among the most modest patients.
“If 3,000 or 4,000 doctors do not agree, we change the scale, it will be significant,” he continues.
On the other hand, Jean-Christophe Nogrette stresses that getting out of the convention “is not easy. Doctors will have to do marketing, find a balance between profitability and affordable prices for the patient”, which is not in their hands. DNA, he believes.
But for Jérôme Marty of UFMLS, between the exasperation of the practitioners and the problem of attractiveness, everything is in place so that intentions become actions.
Source: BFM TV
