Generalized third party payer: why doctors are against

“The generalized third-party payment planned for 2017 is a step forward for patients, and I am committed to it. It is a fundamental part of the health law, and it will be maintained in the law. With these words spoken this morning on BFMTV by Marisol Touraine, it’s hard to believe that the end of the conflict is soon. Especially since the current climate is tense, since at the end of a week of strike, the conflict between the Minister of Health and the unions of liberal doctors is bogged down.
And as the latter have not obtained any major progress on the health law, and in particular on third-party payment, they began a teletransmission strike on Monday. Too long repayment terms, administrative complexity … why actor explains the reasons why this file is not moving forward.

Doctors demand guarantees
In fact, faced with this issue, both parties are sticking to their positions. On the one hand there is the Minister of Health, Marisol Touraine, who speaks of a measure of “social justice”. As such, she often recalls that one in three French people gave up or postponed treatment in 2013 for financial reasons (7th Europ Assistance / CSA Health Barometer). On the other hand, there are liberal doctors who fear an impact on their fees and a measure that is technically difficult to apply. They too are not giving up on the subject.
In detail, doctors first of all dispute the compulsory nature of generalized third-party payment. According to Dr Claude Leicher, president of MG France, whom we interviewed, the practitioner should therefore have the choice to apply it or not. But above all, doctors want guarantees on how they are going to be paid.

Listen to Dr Claude Leicher, president of MG France: “ Well, we don’t want the doctor to have to check the rights beforehand. Nor that he is forced to check line by line that he has been paid. “

Guarantees which according to Marisol Touraine will be provided. The minister in fact frequently affirms in the media that no doctor “will be harmed by this measure. “And to try to further appease the anger of the doctors, François Hollande also knew how to find the words. Guest of France Inter Monday morning he said: “I understand the doctors who say it shouldn’t be complicated. It’s always the same thing, we must not be reimbursed at Saint-Glinglin. They are absolutely right, the doctors, we have to be able to be much simpler, much more efficient, much faster. “

Too long repayment terms
However, the task may not be easy for the President of the Republic if we are to believe a study carried out recently in Tourcoing by theThird party payment observatory. This reveals that the agreed deadlines are not respected in more than 50% of these invoices. And it is for patients in State Medical Aid (SOUL) that the situation would be the most critical.
In figures, for the only paper invoices (FSP), the study finds an average delay of 58 days. And for electronic invoices (FSE), the study finds an average payment period of 6.15 days. Conclusion, the contractual deadlines do not seem to be respected since all of the FSEs should be settled within 5 working days (art. 48 of the agreement), and all of the FSP within 20 days of the act (art. 52 of the agreement). convention).
For its part, Social Security affirms that the contractual deadlines are indeed respected. For the year 2014, the Secu advance that a doctor must wait 3.1 days to be reimbursed for an electronic sheet. And 16.4 days for a paper invoice. It is therefore difficult to disentangle the true from the false. Especially one study presented on Saturday the latter still brings water to the mill of the opponents of the measure. It unveils the late reimbursement records of the Primary Health Insurance Funds (CPAM.)

Listen to Dr Bertrand Legrand, founder of the third-party payment observatory: “ Today we have collected 160,000 invoices. For example, the Yvelines CPAM on paper care sheets can take 440 days to pay for an act. “

And for those who think that this is the exceptional case of a lost invoice, Bertrand Legrand is driving the point home again. Because according to him, “these situations are really frequent. This general practitioner in Tourcoing also claims to be able to publish between 10 and 20% of treatment sheets which have been reimbursed beyond one year.
To conclude, he recalls that a period of one year to be reimbursed, “can lead to cash flow problems in some firms. I am thinking in particular of those who do a lot of third-party payment. “

Listen to Dr Bertrand Legrand : ” These invoices reimbursed late is really common, I assure you. And we have proof. “

A current very complicated third-party payment system
And to explain these invoices reimbursed late, the president of MG France maintains that the current French system is too complicated to generalize third-party payment. “There are in fact 25 compulsory plans, and more than 500 complementary plans,” he explains. But on this point Marisol Touraine often responds to doctors that other professionals have done so, and that other countries have successfully implemented generalized third-party payment. This is particularly the case in Germany, Austria and the Netherlands. But here again Claude Leicher is not totally convinced. “The situations are not comparable,” he says.

Listen to Dr Claude Leicher : ” You have to be careful because in these countries it is not always full third-party payment… “

A possible margin of maneuver
Finally, according to Claude Leicher, all is not lost in these negotiations with the Ministry of Health. He asserts that the subject is still on the table and that everything remains open. Anyway, he warns, if the system proposed by the minister is not technically perfect, his union will ask doctors not to apply it. To find out what it will be, we may have to wait until the end of the next meeting between MG France and Marisol Touraine. This is scheduled for tonight.