Will medical analysis laboratories close their doors in three weeks? Their unions protested at the beginning of August against the reduction in rates that the Health Insurance wants to impose on them. After the refusal to accept their request by the CNAM, they are increasing the pressure this fall. In a joint press release, they threaten, if nothing changes, to call on the profession to strike from Friday, September 20 to Monday, September 23 inclusive, specifying that this closed-door operation will be renewable.
“We are also warning that the CNAM will no longer cover biological tests, in December 2024, as soon as the budget envelope dedicated to medical biology is used up,” the unions add. “We will find ourselves in a bottleneck since Health Insurance will ask us to reimburse these expenses,” explains Jean-Claude Azoulay, president of the National Union of Biologists, evoking with his counterparts “a ‘shut down’ imposed de facto by the CNAM, with total closure of laboratories, probably around mid-December, when this biology envelope is used up.”
Soaring spending on community healthcare
The conflict concerns the application of the memorandum of understanding signed in July 2023, which is supposed to set the rules for the regulation of the sector by Social Security for three years, from 2024 to 2026. After going on strike several times in the winter of 2022-2023 to protest against financial cuts decided by the executive, the biologists had in fact reached an agreement with Health Insurance in the summer of 2023.
It was counting on an increase in biology expenditure of 0.4% per year and implied price reductions of 80 to 90 million euros per year. But, faced with a surge in city care expenditure, the public body wants to free up 120 million euros by the end of the year, based on the downward revision of prices paid to private laboratories for a certain number of procedures. The biologists’ unions denounce the scale of the effort required of them. “We are capable of managing 2% of return, not 5%,” explains Jean-Claude Azoulay.
On the CNAM side, it is reaffirmed: “Health Insurance does not expect any additional effort compared to the elements provided for in the protocol and simply asks for compliance with the terms of the protocol signed last year” and “biology remains a profitable act”. But its general director wrote a letter to the unions this Thursday that opens the way to a resumption of dialogue.
Resumption of dialogue
In this letter, Thomas Fatôme defends himself against any “unilateral” approach by Health Insurance, listing the contacts for the first half of the year. And he puts the amount of savings requested into perspective by explaining that they might “not be enough to respect the level of expenditure provided for by the protocol for 2024”. He also states that “the rating levels will be rediscussed at the beginning of 2025 based on the dynamics observed in the last quarter of 2024 and in the first weeks of 2025”.
Above all, he “invites biologists to resume dialogue within the framework of the protocol signed less than a year ago and to continue to be part of this contractual approach that Health Insurance will continue to support”. “I obviously want to get back in touch with them soon; next week I will suggest that we talk again”, Thomas Fatôme told Les Echos, while insisting on the fact that “there is no question of departing from the protocol’s outline”.
In any case, the decision setting the new rates for procedures is in the pipeline. It does not need ministerial validation to come into force, there is only a right of opposition. Will publication in the “Official Journal” await the appointment of the new government? In any case, the file will be at the top of the pile of the future Minister of Health.
