A great classic of conventional negotiations. Every five years, health insurance and medical unions renegotiate the contract that binds them. And every five years, collectives of professionals emerge and become agitated, with demands that are often very different from those made by the representative organisations. After the independent coordinations and the pigeon doctors in recent years, here are now the “Doctors for tomorrow”. Between the closing of the cabinets in the midst of a “triple epidemic” and a call to demonstrate in Paris this Thursday, January 5, these liberals quickly succeeded in making their watchword heard: the consultation at 50 euros (against 25 today).
A request that the main unions, MG France, the CSMF (confederation of French medical unions) or Avenir-Spé have not accepted. “We share the same anger, but the ‘C’ at 50 euros is exactly the opposite of what we want”, summarizes Dr Agnès Giannetti, the president of MG-France who came first among general practitioners in the last professional elections. These three organizations would prefer to see several levels of consultation appear, at differentiated rates according to their complexity. In fact, an elderly patient suffering from a chronic disease does not require the same time as a young person with no particular history coming for angina… These unions are also demanding a doubling of the “patient doctor’s fee” (a sum paid each year by health insurance according to the number and profiles of patients), and budgets to finance medical assistant positions in private practices.
“At 50 euros for everyone, access to care could become complicated”
Differences of views with the collective “Doctors for tomorrow” which implicitly reflect two very different visions of medical practice. “We defend entrepreneurial medicine, in a liberal spirit. The State has shown with the situation of the hospital that it does not know how to manage health: we believe that the doctor must be able to organize himself as he sees fit and manage with what he earns to recruit his collaborators”, underlines Jérôme Marty, president of the UFML (French Union for a free medicine) and main support of the collective. This general practitioner, therefore, does not want medical assistants financed by the Secu, nor flat rates per patient…
“A consultation fee of 50 euros for everyone will push more and more general practitioners to turn to teleconsultation platforms and unscheduled care centers. This is not how we are going to fight against medical desertification and improve access to healthcare for the French!”, replies Agnès Giannetti. Franck Devulder, the president of the CSMF, also fears that this will lead to a reduction in the medical offer: “We have seen it in other countries, where the prices had been greatly increased under pressure from doctors”. The two unions and Health Insurance share the objective of providing an attending physician to the 600,000 patients suffering from chronic illnesses who do not have one while their pathology requires long-term care. The device they imagined therefore aims to meet this requirement. “In addition, at 50 euros for all, access to care could also become complicated for some French people, especially those without complementary health care”, adds Dr Giannetti. This would be less the case with differentiated tariffs, since the most expensive consultations would primarily concern chronic patients, 100% covered by health insurance.
Strategic disagreements
In addition to these substantive disagreements, there are also differences in form. “When you negotiate with someone, you cannot ask for something totally unacceptable. The consultation at 50 euros is 7 billion in additional public expenditure, while we estimate our requests at 5 billion…”, continues Agnès Giannetti. “In a negotiation, there is what you ask for, but also what you offer. For our part, we have developed a mechanism to provide access to specialists for the entire population. We therefore do not want to break everything at this stage”, adds Dr. Franck Gasser, president of Avenir-spé. Everything is therefore a question of tempo… “Health Insurance accepts the principle of differentiated consultations, which we have been calling for for a long time. Then, everything will depend on the tariff proposals that will be made to us. This will be the subject of discussions in the coming weeks. “, emphasizes Dr. Franck Devulder, President of the CSMF.
Like his colleagues from MG-France and Avenir-spé, Dr. Devulder is however concerned about the means that the Social Security officials will put on the table. The Social Security financing law for 2023 provides for the first time for an evolution of the city medicine budget below inflation. “We are asked to negotiate, but also to save money,” he annoys. “If we see that there is nothing in the bride’s basket, it will not pass,” warns Dr. Giannetti. In this case, the three unions could well, too, call for the cabinets to be closed.