“Through this closure, it is the supply of care that is falling further”, regrets the president of the mutual health center René Laborie, in a press release. The court pronounced, Thursday, February 16, the judicial liquidation of uMen medical, the mutual insurance company which managed this center, created in 1970 in the center of Paris, which employed 135 people and was frequented by 75,000 people a year. “If nothing is done by the public authorities to perpetuate the economic model of health centers, tomorrow it will be more and more difficult for Parisians and more generally for social security holders to access care at agreed rates”, continued Laurent Joseph, the director. He believes that the health center is a victim of health insurance reforms, which have for example prohibited mutual funds from filling the holes in the cash flow of their health centers.
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On the contrary, the employees of the health center criticize the management for having allowed the financial situation to deteriorate after the rupture of ties with the social protection group Audiens, in 2017. In 2021, the health center had lost nearly 1 .4 million euros on a turnover of 10.9 million, after deficits of 2.5 and 2 million in previous years, according to figures from elected staff. According to players in the sector, financial equilibrium remains difficult to find for health centres, despite the recent rebound in the creation of this type of establishment.
Insufficient resources
According to a study by the National Federation of Health Centers (FNDS), the number of health centers with a general medicine offer increased by 44% between 2017 and 2021, often at the initiative of local authorities wishing to fight against medical desertification. “It is common knowledge that the balance of health centers is extremely precarious, there are very few centers that manage not to be in deficit”explains François Demesmay, the director of medical innovation of the group of private clinics Ramsay, which has embarked on a diversification in health centers. “Even if over time we have improved the ability to tend to the balance of the centers, the account is still not there for those who would like to fulfill all their missions”confirms Dr. Eric May, vice-president of the Union of Doctors of Health Centers (USMCS).
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Health centers have many constraints: they can only apply the agreed tariff, must respect third-party payment, have constraints in terms of opening hours and days (8 a.m. to 8 p.m. and opening the Saturday). They also employ employees, who unlike liberal practitioners respect the legal working time, and often have missions of prevention and permanence of care (reception of emergency patients) And to finance all this, they have resources similar to those of self-employed doctors (payment for acts, and additional funding for public health objectives). But these resources are not enough.
Experiments
For Doctor May and François Demesmay, as for Doctor Hélène Colombani, the president of the FNDS, the solution would be to switch to financing the centers “capitation”, that is, replacing fee-for-service funding with an annual lump sum payment for each patient. In this type of financing, “the level of lump sum payment varies with age, gender, social vulnerability, and long-term conditions” of the person being cared for, explains Eric May. The lump sum payment has already been tested by Health Insurance in the municipal health center of Nanterre, directed by Doctor Colombani.
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It is also experienced in five small health centers opened by Ramsay in areas experiencing medical desertification, including three in the Rhône-Alpes region (Bourg-de-Péage, Pierrelatte, Oyonnax) and two in the Paris region (Ris-Orangis and Argenteuil) . “The demographic shift means that the vast majority of the needs” of care of the population “will be chronic pathologies”for which a multidisciplinary follow-up, with a fixed remuneration, is much more suitable than payment for the act, affirms François Demesmay. “The government is trying to promote collective exercise” of medicine faced with the difficulties of access to care, recalls doctor Hélène Colombani.
