The Health Insurance wanted to condition the reimbursement of treatment against sleep apnea to its good compliance. Several personalities denounce this punishment.
It was a small revolution in the French health system. For the first time in France, a treatment was reimbursed only if the patient used it and wisely. Clearly, the patient was only financially supported if he was observant. This change in reimbursement conditions had taken place in the treatment of sleep apnea. Thus, since October 2013, all people who had a continuous positive airway pressure (CPAP) machine were only reimbursed if they used it at least three hours per night for at least 20 days per month.
On February 15, 2014, the Council of State decided to suspend in summary proceedings the execution of this decree of October 22, 2013 taken by Marisol Touraine. The institution explained that it had “serious doubts” about the competence of the government to set up such a mechanism. It is in this context that the think tank “Cooperation Patients” wrote on Tuesday an open letter to the Minister of Health to denounce this project to create a “conditional health insurance”.
Increasing sanctions would accentuate social inequalities
The text in question was co-signed by Christian Saout, former president of the Interassociative Collective on Health (Ciss) and Gérard Raymond (French Association of diabetics). But also 15 personalities (1) recognized in the world of health. In content, he vigorously opposes a health policy based on “watch and punish” (in reference to the work “Birth of the prison, Surveiller et punir” by the philosopher Michel Foucault).
As such, the think tank admits that 50% of the 15 million chronically ill patients, who resort to at least medication, fail to strictly follow their treatment. However, its members believe that they are “neither suicidal” nor “dangerous arsonists” for health expenses.
For this reason, he believes that increasing the penalty would only worsen social inequalities. “In public health, it has long been proven that punishment is not the most effective ‘motivational’ motor for taking care of oneself and living responsibly towards the community.”
Support the patient rather than punish him
Especially since for these groups, alternatives to punishment exist. Among them, support and therapeutic education. Christian Saout and Gérard Raymond are therefore asking for the strengthening of the programs that have started to be implemented since 2009, for a budget of 80 million euros per year (i.e. around 0.1% of the 65 billion euros allocated to long-term illnesses). duration).
He cites the example of the “Sophia” program in which Health Insurance offers support to diabetics, to help them live better and prevent complications. After an experiment in 19 departments, the Sophia service was extended to the whole of France at the start of 2013. And the results drawn up, less than a year after this generalization, are positive. Today, more than 460,000 people with diabetes in France benefit from it. Of the 1.9 million people concerned, nearly 1 in 4 has therefore chosen to join. With the addition of an improvement in the condition of diabetic patients on almost all of the disease indicators.
In addition, these signatories suggest that the next health law, which should be presented in the first quarter of 2014, or the objectives and management agreement between the State and health insurance, include national programming (decided in partnership with patients) to validate patient support models that respect the ethics of care.
Finally, according to the Doctor’s Daily, Coopération Santé had referred the matter to the National Consultative Ethics Committee (CCNE) for it to rule on the issues of recourse to “conditional health insurance”..
(1) Prof. Philippe Amiel, Olga and Christian Baudelot, Régis Bresson, Marina Carrère d’Encausse, Michel Cymes, Prof. Bernard Cassou, Catherine Gilet, Dr Serge Hefez, Prof. Emmanuel Hirsch, Prof. Michel Morin, Prof. Joël Ménard, Claude Rambaud, Dr Brigitte Sandrin, Michel Simon, Bruno Spire, Catherine Tourette-Turgis.
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