When doctors reach their goals, they get a bonus. But for the Court of Auditors, they should be penalized if the objectives are not achieved.
The remuneration of general practitioners according to the achievement of public health objectives (ROSP), was implemented two years ago, to encourage better care. And to compensate for a consultation price that does not increase. In this context, the report of the Court of Auditors may surprise.
“No negative consequences are attached to the non-respect of the objectives or the absence of progress in their achievement, even though this non-respect may pose a public health problem”. In other words, the doctors who do not receive a bonus if the objectives are not reached, should in addition be penalized. A measure that goes against the spirit of this remuneration, based on volunteering, and supposed to be an incentive. Moreover, in order to be able to set up this new system, the Court of Auditors proposes to make the ROSP compulsory. For Dr Jean-Paul Ortiz, president of the CSMF, a union of liberal doctors, “the ROSP aims to promote public health objectives and not to penalize. This bureaucratic idea is totally disconnected from reality ”.
An average premium of nearly 5,800 euros
In 2013, GPs received an average premium of nearly 5,800 euros, which corresponds to a 6.4% increase in 2012 income. And ROSP cost Health Insurance 341 million euros. This is calculated using indicators, which relate on the one hand to the organization of the practice and the quality of service and on the other hand to medical practice. The general rate of achievement of objectives is improving.
Overall, in one year, we went from a rate of 51% to 60% of the objectives achieved. Thus, the liberal doctors are in the process of catching up with their delay in the computerization of practices. This indicator has increased by 12 points in 2 years. Progress has also been made in the monitoring of chronic diseases. On the other hand, according to the report of the Court of Auditors, the results are more mixed with regard to prevention. “The results of indicators relating to influenza are declining and indicators relating to screening for breast and cervical cancer are not progressing.”
A Kafkaesque remuneration system
At the same time as the ROSP, “fixed price” remuneration is developing. But the Court of Auditors denounces a complex and expensive device. “A general practitioner will be able to accumulate, for a diabetic patient over 80 years of age, his fee-for-service, a flat-rate increase of 5 euros for each consultation, performance-based compensation, flat-rate compensation of 40 euros per year for long-term patients, and the annual remuneration of 23 euros if the patient is integrated into the Sofia program ”.
What is certain is that compensation based on targets quickly won over doctors. Only 2.8% of general practitioners and 4.4% of specialists refused it. A rate that could be much lower if the threat of penalty were to hover.
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