Better reimbursing the members of complementary insurance for their care is what mutuals want. To the detriment of the freedom of choice of doctors, argues the profession.
Paying 40% less for glasses, who would be against? No one, especially in a country where “glasses are twice as expensive as our German neighbors”, underlines Mathias Matallah, president of Jalma, a consulting firm specializing in the field of health. To act on the price of health care, a solution is currently being put forward: healthcare networks. After the battle over fee overruns, it is that of the care networks that is raging. A bill from the PS group is currently being debated in parliament. This text, if adopted, would allow mutuals to create care networks like their cousins, private insurers. In other words, to contract health professionals and guarantee members who consult them a better reimbursement.
The subject is hot and violently opposes doctors and mutuals. However, “a few years ago, we would not even have discussed this subject, believes health economist Claude Le Pen. But, today, the complementary ones say to themselves that they have every legitimacy to regulate the system since it is they who take care of the overruns, who pay the third-party payer ”. And no one disputes the urgency of regulating the supply of care at a time when access to care for the French is one of the priorities of the various governments which follow one another.
Regulating the supply of care is therefore a necessity. The High Council of Health Insurance and the Court of Auditors are calling for better organization. It remains to be seen how. For the PS group, which tabled the bill, the care networks must “allow mutual societies to fully play their regulatory role”.
The system already exists for dental care and especially in the optical sector. If it is declined to all medical acts, mutuals would take better charge of fees, doctors would be assured of having a flow of solvent patients. In exchange, the complementary would of course have requirements. “They could, for example, in certain cases require a second opinion or even ask doctors to prescribe generics … In short, make compulsory things on which there are currently only incentives,” summarizes Claude Le Pen.
Doctors do not compromise on the practitioner’s freedom of choice
For the health economist, it is not “fundamentally more shocking than the approved garages of certain mutuals”. But, doctors do not hear it that way.
For medical interns, this bill “undermines the principle of free choice of the patient and the independence of the practice of the doctor. Rejecting this bill has even become their main demand for their protest movement. “The strong media mobilization initially motivated by demands on working conditions and free pricing is gradually shifting to the unhealthy involvement of complementary health in our healthcare system. This is why it will be our main demand from now on, ”explained the national inter-union of hospital interns (Isnih) in a press release dated November 15.
Faced with this sling, the Minister of Health softened the text. It is now stipulated in black and white that the free choice of health professional will be respected and these conventions should not concern either general practitioners or specialists.
Inescapable or fantasy ? !
But for Claude Le Pen, “it seems difficult to escape this system. In any case, all the pillars of liberal medicine are already seriously damaged. However, the health economist recognizes that “the slope is soapy” and that these networks of care are leading us “towards a form of privatization of health. It will therefore be necessary to constantly ask ourselves whether the compensation requested does not go against the interests of patients. ”
Mathias Matallah, president of the Jalma consulting firm, believes that “healthcare networks for something other than optics, dentistry and hearing aids, it’s a fantasy! Health insurance and the public authorities hold the reins of the sector and they do not intend to let go. ”
When signing the agreement on fee overruns, mutuals were not invited to negotiations. “The specter of American-style medicine in the hands of private insurers is propaganda,” continues Mathias Matallah. In the United States, a general practitioner consultation costs $ 150. The issue of cost control therefore has nothing to do with France. “
Contrasting results of the networks in the optics
Despite everything, do policyholders have an interest in having powerful mutuals more involved? Yes, according to the mutuals themselves. An Ipsos survey carried out for the French Mutual Fund revealed that 81% of eyeglass buyers who went through opticians who were members of an approved network were satisfied with their purchase, against 71% for all eyeglass wearers. But opponents of the systems are also waving their polls. A study carried out by the firm Galileo Business Consulting for the Centrale des opticiens (which brings together independents) showed that 39% of consumers who could have access to an approved optician did not opt for the network. Free choice of practitioner would weigh more heavily in the balance than reimbursement rates.
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