Is there a risk of slipping into a two-speed health system?

A year that this threat takes shape. On March 3 and 4, the French Union for Free Medicine (UFML), the union of ultra-liberal doctors, is organizing the deconvention meeting. An event planned for a long time… well before the conventional negotiations between the doctors and the Secu, which ended in failure. This meeting will bring together doctors tempted to dissociate themselves from Health Insurance to reconnect with tariff freedom… even if it means creating an English-style health system.

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“Go ahead, we will count the points at the end of the game!”, annoys Gérard Raymond, president of France Asso Santé, the association which represents users of the health system. It is “to penalize the French even more, to create a two-speed medicine. Only the rich can heal themselves. This is not the spirit of Social Security”, estimated the Minister of Health and Prevention, François Braun, Monday February 27 at the microphone of France Inter. The ex-emergency physician, however, is not afraid of a massive wave of disconcerted doctors…. Wrong?

An ultimatum to bend the government

“The threat is real. It is not a question of an individual but collective deconvention”, maintains Dr. Jérôme Marty, president of the UFML. This general practitioner who practices in Fronton (Haute-Garonne) hopes to convince “15 to 20,000” doctors to slam the door of the primary health insurance funds (CPAM).

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Everything is planned down to the smallest detail. “At the assizes, Saturday at 5 p.m., doctors who wish to do so will be able to deposit their letters of deconvention in a ballot box in the presence of a bailiff”, says Dr. Marty. Those who did not attend the event will be able to submit their letter digitally. If he is impatient to charge his basic consultation at 50 euros instead of 25 today, the leader of the UFML first seeks to issue an ultimatum to the government. “We have been in a system financed in the same way since 1947. This model is running out of steam. We have to put everything back together”, he insists.

To put pressure, the general practitioner wants to “blow up” the so-called health insurance authority tariff. This is the reimbursement applied by the Sécu to patients who have consulted a non-contracted doctor, in other words practicing in “sector 3”. The amounts of support are now extremely low: 0.66 euro if you consult a general practitioner, 1.22 euro for a specialist. And this, while these professionals are not under agreement, in particular to charge much higher prices than those imposed on doctors in sector 1 and to a lesser extent on those in sector 2. “Today, case law justifies this tariff of authority because only 0.7% of doctors are not under agreement. If tomorrow, several thousand doctors disagree, it will be another story”, warns Dr Jérôme Marty.

Towards a privatization of the health system

But what to expect if the government does not let go? “We started talking to the mutual insurance companies so that the French are as little harmed as possible”, continues the president of the UFML. The goal would be to create a parallel health system… detached from the public authorities. But you still have to pay a complementary health insurance that will cover your care well. “If we don’t overhaul the health system, there will be, on the one hand, public medicine for the poor, financed by Social Security, then very quickly by the State, which will take over. And on the other, a private medicine low-cost for the middle class and finally a medicine premium for the rich. Like in England”, warns Frédéric Bizard, president of the Health Institute and professor of economics at ESCP Business School.

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This economist is not surprised by the fact that the negotiations between the liberal doctors and Social Security have failed. “We are trying to make an old model survive with a very technocratic vision. However, we are in a health system that is no longer adapted to the aging of the population and the increase in chronic pathologies”, he analyzes.

react quickly

Usually neutral on the subject, the College of Physicians does not hide its concerns. “The financial difficulties in accessing healthcare are worrying. We must prevent doctors from going as far as deconvention, which would reflect a serious lack of listening on the part of the authorities”, considers Dr Jean-Marcel Mourgues, the vice-president of this institution.

There is therefore an urgent need to react, according to Frédéric Bizard. Because the entourage of the Minister of Health does not seem more worried than that about the risk of a massive disappointment of doctors. “If the doctors end up settling in sector 3 to raise their prices to 50 euros, if they agree to return to the bosom of Social Security, they will do so on condition that they maintain this same price”. However, the boss of the Secu, Thomas Fatôme, like François Braun, have several times brushed aside this doubling of the price of the consultation of general practitioners. See you on Saturday March 4 to find out if the government will have cold sweats.

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