Five years after its implementation, the ROSP has improved medical practices. But significant progress remains to be made on vaccination and screening.
The remuneration on objectives (Rosp) of the liberal doctors reached its objective. After 5 years of implementation, the assessment of this device “is generally positive and testifies to its interest as a lever for the evolution of the practices of liberal doctors”, reports this Monday a report from the Health Insurance (Cnamts) on the five years of existence of this device.
The Cnamts adds that this new report confirms that this additional remuneration paid to more than 90,700 independent doctors (general practitioners or specialists) encourages “better management of chronic diseases and a more relevant and efficient prescription”.
It is also part of their income now. In 2016, these doctors received 4,593 euros on average, compared to 4,514 euros in 2015. Big winners, general practitioners with 6,983 euros received on average in 2016.
Prescribe better
To receive these bonuses, city practitioners must meet several criteria relating to their clinical practice (prescription, monitoring of chronic diseases, prevention), the efficiency of their prescriptions (generic) but also the organization of their practice (use of certain software).
For the year 2016, the Health Insurance welcomes a continuous improvement in the follow-up of diabetic patients, “essential to prevent and avoid complications from this serious pathology”. This positive development was particularly marked for the glycated hemoglobin assays, which were carried out more often. Similarly, the proportion of patients at high cardiovascular risk treated with statins and aspirin has increased.
Painful prevention
Regarding the prevention component, the results are mixed. The Cnamts notes an increase in the taking into account of drug iatrogenics in the over 65s responsible for numerous hospitalizations. It is also pleased with the reduction in the use of antibiotics: at least 2 million prescriptions were avoided in 2016.
But at the same time, flu vaccination and screening for breast or uterine cancers are lacking. The proportion of vaccinated patients aged 65 and over has fallen by 5.1 points, and that of adults with long-term illness (ALD) has fallen by 1.7 points since 2011.
“This trend is not the result of factors in the sole hands of physicians, hence the importance of acting collectively and strengthening the mobilization of stakeholders”, underlines the report.
Same observation for the realization of the smear or the mammography. While 80% of women should have these exams, 62% of women aged 25 to 65 have had a Pap smear in the last 3 years and barely 56% of women aged 50 to 74 have had a mammogram in the last 2 years.
A Rosp fitted out in 2017
Based on these lessons, the device has been renewed for the next 5 years under the new medical convention. It will focus on the clinical practice of physicians declined through 3 components: the follow-up of chronic patients, the efficiency of prescriptions and prevention. The latter will represent more than 40% of the points of the new version of the Rosp.
The system will also extend to the monitoring of children by the attending physician. A dozen indicators have been created, such as dental monitoring, obesity or vaccination.
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