The Council of State suspended a decree which set up a monitoring system for patients suffering from sleep apnea. Patients were reimbursed only on condition of being observant.
Reimbursing a treatment only if it is well followed, the idea was innovative. The Council of State decided Friday to suspend in summary proceedings the execution of the decree of October 22, 2013 which conditioned the reimbursement by Social Security of a treatment against sleep apnea on its proper use. The institution explained that it had “serious doubts” about the government’s competence to set up such a mechanism.
Thus, since October 2013, all people with a continuous positive airway pressure (CPAP) device – prescribed for sleep apnea – are only reimbursed if they use it at least three hours per night for at least 20 days a month. To ensure that they use this equipment, which is very expensive, patients have been placed under “remote observance”: the CPAP machines are equipped with a cookie which records the number of hours during which it is used. . The suspended decree provided that below three hours of use per night for two months, the rate of coverage by social security drops by half. After four months of poor compliance, the patient was no longer reimbursed and no new treatment was accepted for six months. This systematic “remote observance” coupled with conditional reimbursement should concern all patients by 2016, ie more than 600,000 people.
An unjustified expense of nearly 80 million euros per year
The Ministry of Health and Medicare had argued that the underuse of CPAP was detrimental not only to the health of patients, but also to public finances with an “unjustified” expenditure estimated at nearly 80 million d euros per year.
The decree had made doctors cringe. “Encouraging patients to be observant does not seem shocking to us, but this economic measure is not based on medical arguments”, explained to pourquoidocteur.fr on January 31st Dr. Sylvie Royant-Parola, psychiatrist, sleep specialist, and president of the Morphée network. “No scientific study has made it possible to determine whether 3 hours of compliance is indeed the threshold from which the treatment is effective.”
In addition to the summary, the Council of State will have to decide on the merits. PPC reimbursements exceeded € 400 million in 2012, up 11% from 2011.
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