In this last day of conventional negotiations, a signature of the medical unions is moving away. Organizations are multiplying the disappointed press releases of the tariff increases.
Since Tuesday, the liberal doctors’ unions have participated in the last round of tariff discussions with Health Insurance. The final session of conventional negotiations in order to arrive at a text therefore takes place this Thursday. And the least we can say is that the new medical agreement is not ready to be signed.
In a press release published on Wednesday, the CSMF (1) Jeunes Médecins wrote: “What disappointment and anger after these 2 days of conventional negotiations! “And” The CSMF JM can only note the lack of ambition and innovation of the latest proposals from the Caisse Nationale d’Assurance Maladie (CNAM) “.
The calendar of the C to 25 rejected
The first union of liberal doctors thinks in particular that the recognition of their daily work does not pass only by 2 € additional on the basic consultation of the general practitioners.
But worse for the latter, the Health Insurance offers an increase in two stages: from 23 to 24 euros in April 2017, and from 24 to 25 euros in April 2018. “We will not sign an increase in two times”, repeated to on this subject, Dr Claude Leicher, president of MG France, the first general practitioner union.
The structure package is not sufficient
Another point of tension, the structural package requested by the unions. It is intended to finance the equipment and organization of practices. The Fédération des Médecins de France (FMF) considered that it should not be less than € 50,000 per year, “Even if the structure package could be variable depending on the place of installation and the mode of exercise isolated or grouped”, she specified.
But the union was obviously not heard. In an open letter addressed to the director of the CNAM on this last day of the negotiations, Jean-Paul Hamon, president of the organization, speaks of “a mess”. He accuses him of having covered several subjects such as third-party payment, and the permanence of care, among others.
The forgotten specialists?
Finally, many specialists complain about a negotiation which would have forgotten them. The CSMF therefore wonders “if they will have to be satisfied with minimal adjustments on the key letters”. “Will we see concrete proposals for specialties in great danger such as pediatrics and endocrinology? How to ensure coordinated care for elderly patients if general practitioners no longer have their local specialist correspondents? », Asks the union.
The CNAM in fact offers them the upgrading of complex consultations (one-off consultant opinion). They would be increased to 48 euros, against 46 euros offered last week. What’s more, the coordination increase provided by specialists and general practitioners would drop from 3 to 5 euros. It is this which allows a specialist to bill his consultation 28 euros instead of 25 when a patient is referred to him by a doctor. With the proposed increase, this consultation would therefore reach 30 euros. So not enough for the unions.
(1) Confederation of French Medical Syndicates
The arbitral rules
As a reminder, the medical unions and the Health Insurance have until August 26 to agree on a text. If they do not succeed, other rules of the game are in order. Author of the book “From trade unionism to convention, the history of a long river not so quiet”, Dr Patrick Carlioz explained that “at least three signatures will be needed for a new medical convention to come into force” . “If this is not the case, it is a minimum arbitration rule which will emerge”, he specified.
The arbitrator, who is none other than the president of the High Council for the Family, Bertrand Fragonard, will fix by decree the new relations between the Health Insurance and the liberal doctors so that the patients continue to be reimbursed. The worst option for all the unions at the table.
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