The deputies adopted the selective agreement of the liberal doctors in zone “overdense”, during the examination in committee of the bill of financing of the Social security.
In 2015, the Order of Physicians listed 192 medical deserts in which nearly 2.5 million people live. In order to fight against the worsening of this phenomenon, deputies have thought of a solution that raises controversy. Socialist deputy Annie Le Houérou (Côtes d’Armor), supported by around forty parliamentarians including the president of the social affairs committee Catherine Lemorton (PS), submitted an amendment to constrain the freedom of installation of liberal doctors by a selective agreement.
And the text was adopted on Wednesday during the committee’s examination of the 2017 Social Security Financing Bill (PLFSS). It provides that within the areas defined by the Regional Health Agencies (ARS) “in In consultation with the medical unions in which there is a strong surplus in terms of the supply of care, a new liberal doctor can only set up with a health insurance agreement when a liberal doctor from the same area ceases his activity ” .
A “complementary” device
Anticipating the rebellion of liberal doctors, the text specifies that “the principle of freedom of installation therefore remains, but agreement is only possible selectively for new installations”. For these representatives in the National Assembly, it is only a question of extending to liberal physicians a system of regulation to the installation which already exists for several other health professionals (pharmacies, nurses, masseurs-physiotherapists, midwives , dentists, speech therapists).
And the deputies who are in favor of it see only virtues, since the amendment ends as follows: “the adoption of such a principle (…) would make it possible to supplement” usefully “the mechanisms of incitement to installation in under-resourced areas which have been set up as part of the territory-health pact. In terms of the fight against medical deserts, it is urgent to mobilize all possible solutions, in particular when these have already proved their worth for other health professions ”.
The medical unions wind up
The liberal doctors’ unions are far from sharing this opinion. The CSMF (1), the first liberal union, declared in a press release: “When will we understand that freedom of installation is a pillar of liberal practice and that we cannot ask doctors who have a liberal status to compensate for the State’s disengagement from public services? “.
She also recalls that it is very difficult for a doctor to settle with his family in a town where there is no or almost no school, post office, train station, etc. “When will we understand that young people today are slow to settle in front of the constraints of liberal medical practice? “For the union, the solution to the medical deserts must pass through” a panel of incentives which will make the professional life of the doctor compatible with current societal developments “. Same tone on the side of the Order of Physicians who, in a press release, formally calls on the Minister of Health, on behalf of the Government, to oppose this amendment
As a reminder, exercising outside of the conventional system is a risky option for physicians. Even if they have total tariff freedom, the Health Insurance does not cover part of the social contributions. As a result, the price of these consultations is higher. A damaging situation for patients who are reimbursed on the basis of a very low authority rate set at € 0.98. In reality, this means almost no reimbursement for the patient, unless the mutual fund covers the costs of its member. The patient population of doctors opting for this choice could therefore shrink.
Generalists: an endangered species?
The latest figures published in June 2016 by the Order of Physicians concerning medical demography are particularly alarming, especially for general medicine. The situation is also worrying for certain medical specialties. As of January 1, 2016, France had 88,886 general practitioners “in regular activity” compared to 97,012 in 2007, ie a drop of nearly 10,000 general practitioners in activity in less than 10 years.
According to projections by the Council of the Order (CNOM), this decline should increase over the next 10 years with, over the period 2007-2025, the retirement of one in four general practitioners. If rural areas are particularly suffering, medical desertification also affects peri-urban areas, and the heart of some large cities.
(1) Confederation of French Medical Syndicates
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