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Dr Gérald Kierzek (Medical Director)
While the negotiation between Cnam and general practitioners to decide on a new consultation tariff (sector 1) ends in failure, some unions are brandishing the threat of “deconvention”. But what is it?
We were talking about it again yesterday in Doctissimo: the negotiations between Health Insurance and liberal doctors, supposed to set the new scale of consultation fees for the next five years, were unsuccessful on Tuesday. The Health Insurance proposal to switch to a price of 30 euros, against new constraints, or 26.50 euros without compensation, did not convince. Worse, it has angered a certain part of the doctors’ unions. “There is more than 40% of the profession which is in burnout, and we hear the guardians telling us, you will have an increase taking into account inflation, but only if you work more”testified Agnès Giannotti, president of the union at MG France.
Doctors say they are ready to charge their own prices
For the time being, no change is to be considered for patients, it is the current agreement that continues to apply, and the new pricing, if agreed, would not come into force before October 2024. Given the failure of negotiations, it is now a price list by arbitration which will be given within 3 months which will apply. But some unions do not intend to wait and brandish the threat of deconvention. This means that they would decide to practice outside the agreement, and their own rates without more practice those reimbursed by Social Security.
In the lines of France Info, on February 27, Jérôme Marty, the president of the French Union for a free medicine warned: “Today there are thousands and thousands of doctors who are beginning to look at deconvention as a way out of the convention [avec l’Assurance maladie] and go and build another sector with private insurance, with mutuals, etc. We’re here today, it’s historic.” The UFML, which demanded an unconditional increase and a consultation at 50 euros for all general practitioners, also announced a deconvention meeting in March.
Agreement, deconvention… What does that mean?
Consulted on the subject, Dr. Emanuel Loeb, president of the Young Doctors union, reminds us of what the convention is and this announced deconvention, to better understand what it is about: “The agreement is a joint contract that exists between doctors and health insurance, which is therefore insurance, and whose funds are linked to social contributions for the most part. The doctors have therefore agreed to regulate their fees in return for a solvency of these fees by national solidarity collected by Health Insurance.
Thus, at each convention, the Health Insurance and the medical representation discuss together the rates that they consider fair with regard to the valuation of the medical act.
“Today, because of inflation, doctors consider that the value of their work is not up to what they expect. This temptation to come out of agreement to fix these fees yourself is felt by some, especially since the medical offer being rare, they tell themselves that there will always be people ready to pay fees.
But as Dr. Loeb explains, this deconvention is not necessarily a panacea:
“On the one hand, patients will not be reimbursed in the same way according to the mutual insurance companies with which the doctors have signed a contract. But these insurances, which would make doctors solvent, will also put constraints. The El Dorado at the start can quickly turn into a golden cage.”
The fear of two-tier medicine
For now, the déconvention posed on the table is not yet a reality. According to the Ministry of Health, which says it hears this threat, the practice currently concerns “just under 1%” of practitioners.
And its practice is not desirable for Dr. Kierzek, medical director of Doctissimo:
“The French are attached to their social model, we cannot imagine that there is no reimbursement. This would create a two-tier medicine, for the rich as far as non-contracted doctors are concerned. This also poses a problem of social security contributions: what would be the point of contributing to social security if visits to your doctor can no longer be reimbursed?“ he concludes.