The private international group Ramsay Santé, which has 175 commercial clinics in France and whose turnover in France is estimated at 4 billion euros, has just put on the market a medical teleconsultation offer operating 24 hours a day. -four, day and night, including Sundays and public holidays, giving access without an appointment and without waiting to practitioners from 20 different disciplines (from general medicine to gynecology, via psychiatry and dermatology, etc.), for the cost of a monthly subscription of 11.90 euros, or 142.80 euros per year. Only limit, a maximum of 20 annual teleconsultations.
But what is the Ramsay group looking for with such an offer? On the economic level, to make money, without a doubt, since the logic of the private sector listed on the stock market is to make profits and remunerate shareholders. It is therefore legitimate to question the economic model. To be remunerated by a logic of subscription as for telephone operators or streaming platforms by attracting the greatest number? Refer patients for additional explorations within the Ramsay group, highly profitable explorations? Capture patients in primary health care for possible referrals for surgical interventions? But what about health? At first glance, it would be a matter of promoting access to care at a time when this access has become very problematic. Yes, but here we are, this type of solution is the opposite extreme of what the Ministry of Health and Medicare are trying to implement.
Either it is an emergency, and the request does not come from the Ramsay Santé teleconsultation service, but from a telephone call to the healthcare access service (the SAS), by dialing 15. Trained regulators then determine the appropriate response to the patient’s case: dispatch of an ambulance from the Samu, recourse to hospital emergencies or a consultation appointment in town within forty-eight hours.
Either it is a non-urgent consultation request, but then one wonders why Ramsay offers a service every day, 24 hours a day, therefore including the night and without delay?
An “uberization” of medicine
But what medicine is it? A medicine without clinical examination (neither touch, nor palpation, nor auscultation…) and without follow-up, but still with teletransmitted prescriptions. Ramsay took the precaution of specifying that these teleconsultations did not replace regular medical follow-up or occasional consultations with the attending physician, but were only added to the usual course of care? A pseudo-medicine that violates the rules of telemedicine, set in 2018 by conventional agreement between Social Security and representatives of liberal doctors and approved by the National Council of the Order of Physicians. This agreement stipulates that telemedicine, apart from emergencies, cannot replace an initial consultation. The doctor must “know” the patient and, therefore, have received him physically for consultation at least once during the previous year. The teleconsultation must take place as part of the patient’s follow-up. It must not exceed 20% of the professional’s activity.
Finally, what is Ramsay’s offer the name of? She does not respond to emergencies; it is not part of a medical follow-up; it is not aimed at people living in a rural or peri-urban medical desert (those who teleconsult are more young, urban and less precarious, according to a study by DREES); it excludes the possibility of a clinical examination. It is in fact simple tele-interviews or, worse, a “remote-command” of prescription by the subscriber. The purpose is, alas, obvious: it is a question of draining the clientele towards the lucrative centers and clinics of the Ramsay group. This is the client’s recruitment teleconsultation. The doctors, them, by fraudulently ticking the “emergency” box, could be paid by Medicare.
This “uberization” of medicine should be prohibited by the order of doctors. Basically, such an approach is a way to continue to deregulate our suffering health system, to enter into the logic of the commodification of care and the financialization of health according to the principle that when health is public, at the service of all , it costs, while when it is private it yields.
In truth, one subscribes neither to sickness nor to health. An egalitarian and supportive health system is both more effective and more efficient. It remains to be understood why Social Security is ready to reimburse this degraded pseudo-medicine and why the Minister is silent. Would this offer be part of the “toolbox” of the National Renovation Council (CNR)? Health is a superior good that must be placed outside the laws of the market, the president solemnly declared. It is time for these words of common sense to be acted upon.
* André Grimaldi, professor emeritus at the CHU de la Pitié-Salpêtrière, and François Bourdillon, former director of Public Health France, are the co-hosts of the Collective of professionals and patients for the overhaul of the health system.