Turn of the screw in sight on unjustified work stoppages

Turn of the screw in sight on unjustified work stoppages

2023-09-26 19:16:10

Published on September 26, 2023 at 5:16 p.m. Updated on September 26, 2023 at 7:16 p.m.

Faced with the strong growth in compensation for sick leave, the government has decided not to impose a non-reimbursed waiting day (neither by Social Security nor by insurers) for private sector employees and has discussed consultation with the social partners. But without delay, he is returning to the charge in the Social Security financing bill for 2024 in order to tighten controls and sanction unjustified stoppages.

The executive intends, first of all, to prevent doctors from prescribing sick leave of more than three days by teleconsultation. Unless it is the treating doctor of the patient in question, according to budgetary documents consulted by “Les Echos”. A turn of the screw had already been recommended by Health Insurance this summer.

Teleconsultations already in the viewfinder last year

Why this limit? “If the state of health of the insured person does not improve, or even worsens, beyond a period of three days, it is necessary that he or she can be physically examined,” argues the draft budget. of Social Security, which will be unveiled this Wednesday in the Council of Ministers.

Already last year, the government had planned to no longer cover work stoppages prescribed by teleconsultation, unless it is a decision taken by the patient’s treating physician or a doctor consulted. during this year. Presented as a way of preventing abuses in teleconsultations which developed with the Covid crisis, this turn of the screw had been reversed by the Constitutional Council.

In the eyes of the Sages, it is not because a work stoppage is prescribed via teleconsultation that it is unjustified. What’s more, patients may turn to teleconsultations because they are unable to quickly contact their attending physician.

To avoid a new veto, the budget drawn up by the government provides that it will be possible to prescribe outages longer than three days if they come from a treating doctor and “in case of impossibility, duly justified by the patient” to physically go to a doctor.

Furthermore, the government plans to only authorize treatment of medications or treatments prescribed by teleconsultation if they “have been the subject of an oral, video transmission or telephone exchange”. In other words, there is no question of reimbursing medications prescribed following an exchange by “chat” or SMS.

Spending slippage

So many “safeguards” supposed to “guarantee the quality of care” and “avoid abuses”. The government is also concerned about the rapid increase in the cost of work stoppages, despite the end of the pandemic. This increased by more than 8% between 2021 and 2022 to exceed 14 billion euros (if we put aside the shutdowns linked to Covid).

The increase in the daily allowance bill can be explained by the aging of the working population, the rise in wages which increases the average allowance and the increase in activity. But these factors “do not alone explain” the slippage in spending, estimates the executive in its draft budget.

In addition to regulating work stoppage prescriptions by teleconsultation, the government plans to include provisions in the next budget to “reduce unjustified work stoppages by improving and facilitating controls on prescribers and insured persons”.

Accentuate sanctions

This would include strengthening the control capacities of health insurance funds and employers, and “increasing sanctions in the event of undue work stoppage”. Work stoppage could no longer be compensated by Social Security as soon as it is considered unjustified by a “medical inspector delegated by the employer”.

“Penalties could also be imposed in the event of successive unjustified shutdowns,” notes the draft budget consulted by “Les Echos”. The idea is also “to intensify support for doctors with a high rate of sick leave orders”.

A sensible subject. Liberal doctors have already become annoyed by the controls launched on sick leave prescriptions by Health Insurance. This ensures that they are targeted and that it ensures that doctors are supported. The question, however, poisons relations between the unions and Health Insurance as they must resume discussions on the price of consultations.

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