The negotiations between the liberal doctors and the health insurance ended on Thursday, February 23, as they took place, in a tense climate. Discussions to define the links between Social Security and doctors for the next five years have been tough, especially on the thorny issue of the amount of the consultation.
30 €, sous conditions
From the start of negotiations in November 2022, general practitioners mobilized to demand – among other things – a substantial increase in prices. The majority unions demanded a change from €25 to €30, but the “Doctors for tomorrow” collective went so far as to ask for a doubling of the price. Since then, several days of strikes have taken place. The latest, on February 14, led to the closure of a large number of surgeries and was even monitored by SOS Médecins.
After nearly four months of discussions, the National Health Insurance Fund proposed an increase limited to €1.50 per consultation, enough to rekindle tensions. She suggests that this rate could be increased to €30 under certain conditions, such as the hiring of medical assistants, an increase in the number of patients or regular call duty on Saturday mornings.
The director of the National Health Insurance Fund (Cnam), Thomas Fatôme, estimates that this device would allow 2 million additional French people to find a doctor, while 6 million of them do not have one. For medical specialists, the new proposed tariff would amount to €35.
February 28 deadline
This proposal is unsatisfactory for the majority of doctors’ unions. “The government wants doctors who are committed to taking more patients and working more, but it has not taken into account the specificities of the profession”, deplores Jérôme Marty, president of the French Union for Free Medicine (UFML). The health insurance assures that it would not be a question of “fundamentally work more, but organize themselves differently to meet the needs of the population”.
According to the Cnam, 40% of general practitioners already have enough patients to claim a consultation fee of €30. But the principle of a conditional rate increase continues to “stagger” the Confederation of French Medical Unions (CSMF). “The 60% of doctors who do not meet the conditions to obtain a consultation fee of €30 are already angry”, says Luc Duquesnel, its president.
Soon the foundations of deconvention
The proposals for the new agreement are not up to par, says MG France, the union of general practitioners, who accuses the government “not investing enough to save the health system”. “We are not fighting to have more money in our bank account at the end of the month, but to make the job attractive again and that young people settle down”assures its president, Jean-Christophe Nogrette.
According to the Cnam, it is precisely the possibility of raising the consultation fee – provided that several commitments are respected – which will make it possible to strengthen the attractiveness of liberal medicine for young people. While strengthening the “guarantee of access to care”.
The unions have until Tuesday, February 28 to accept or not the proposals of Social Security. The organizations continued their reflection this weekend, some awaiting the result of the votes of their members, to decide on their signature. Sunday evening, the two main unions of liberal doctors, among general practitioners and specialists, announced their rejection ” unanimously “ new consultation rates, in return for a commitment to increase their activity.
Failing agreement, the Cnam will rely on an arbitrator – in this case Annick Morel, former general inspector of social affairs – who will have three months to write the future agreement. These arbitration rules may be kept for five years, with the obligation to resume negotiations in two years.
Convinced of the endangerment of liberal medicine, the UFML has already announced the holding of “assizes of deconvention”, on March 2 and 3 next.