Demonstration against a project to reform the installation of doctors, in Toulon, November 13, 2015
To cure the health insurance of its chronic deficits, the Court of Auditors wants to inscribe in the law a „rule of equilibrium“ which will force it to make savings, thanks in particular to an arsenal of coercive financial measures against the liberal doctors.
The health insurance „has not found the balance for 25 years“, causing „the accumulation of a considerable social debt,“ said the Court of Auditors in a report released Wednesday.
„This situation is dangerous“ and requires, according to magistrates of the street Cambon, a radical remedy: to establish a rule „obliging to present and to vote his accounts without deficit“.
In the face of the announced explosion of expenditures related to aging, chronic diseases and new treatments, it will be necessary to „tap into deposits of efficiency“ to meet this goal. Clearly, tighten all the screws.
For example, in the hospital „the simple readjustment of tariffs in some areas (…) would allow to consider high gains close to 2 billion euros,“ says the Court, which advocates a gradual alignment “ on the costs observed in the most efficient establishments „.
Another path identified: generic drugs, which would release „nearly 2 billion euros additional“, combining higher volumes and lower prices.
But the most explosive measures are reserved for liberal doctors, whose negotiations with the Health Insurance lead to „mediocre results“ and go from reforms „bogged down“ into „insurmountable disagreements“.
Since „disappointments accumulate“, the Court of Auditors recommends changing the method: finished the carrot, batting.
– The weapon of deconventionation –
Finally, in order to bring a „stop“ to the overruns, the report suggests to include in the law „capping rules (…) leading, in the event of non-compliance, to the exclusion of health in question „.
A penalty synonymous with a reimbursement for patients, the consultation with a non-approved doctor being refunded only between 60 cents and 1.20 euro by Social Security.
The same type of constraint is recommended „to achieve a rebalancing“ of the geographical distribution of doctors: the Court of Accounts wants to replace their freedom of installation by the „selective convention“, already applied to nurses and midwives.
Two options are envisaged: a measure limited to the „best endowed areas“ or a national scheme with „a target number of agreed posts“ in each territory.
The report also mentions the possibility of forcing young graduates to practice „in under-dense areas for a fixed period of time“ before settling in as a liberal.
The stake is also financial, a homogeneous distribution of the liberal doctors on the territory being able to generate „potential gains of efficiency“ of 800 million to 1.4 billion euros according to the report.
Other forms of financial constraint are proposed, such as the creation of „limiting envelopes“ by region to „limit the number of acts and prescriptions“ of the liberal doctors.
Magistrates also advise linking „part of the salaries of doctors“ to their participation in the permanence of care, to remedy their „insufficient availability, especially early in the morning or in the evening“ and thus relieve hospital emergencies.