No deal in sight. After several months of tense discussions, the six unions representing liberal doctors have until Tuesday evening to say whether or not they accept the new fee schedule proposed by Health Insurance for the next five years.
But probably, “there will be no agreement by Tuesday evening, it’s almost certain”, declared this Monday morning on France Inter the Minister of Health François Braun, taking note of the failure negotiations. So, in the absence of an agreement, what should we expect? Can this showdown between doctors on one side and Secu and government on the other lead to anything other than a dead end? Can doctors still obtain a satisfactory upgrade without going through an agreement? Not sure.
What proposals have been made?
As part of the negotiations, the Sécu proposed an annual envelope of 1.5 billion euros, providing in particular to revalue all medical consultations by 1.50 euro. Or 26.50 euros for the basic rate for general practitioners, maintained at 25 euros since 2017. Another proposed measure: the “territorial commitment contract”, opening the way to a consultation at 30 euros for general practitioners, “provided – it is up to you – as we are reminded in the entourage of the Minister of Health – to see more patients, to consult on Saturday mornings, or even to practice in a medical desert”. Conditions already met by more than 40% of doctors, according to the ministry, “and which would have allowed them to earn an average of 20,000 euros more per year, while requiring an additional effort from others to meet the health needs of the French” , insists the entourage of the minister, for whom “unconditional revaluation was not an option”, especially in view of the “colossal sums” at stake.
What were the unions’ responses?
The unions are overwhelmingly against the proposals on the table. The union of general practitioners MG France expressed its refusal “unanimously” within the framework of an internal vote, underlined its president Agnès Gianotti. “MG France refuses a text which conditions the simple upgrade of the price of their basic act to additional constraints, reacted on Monday the first union of general practitioners. The government did not understand the malaise of this profession, and Health Insurance did not measure the lack of attractiveness of this complex medical specialty, whose average fees remain 40% lower than the average fees of other specialties. . An opinion shared by the Avenir Spé-Le Bloc union, which brings together specialists, and which announced its opposition to the text on Sunday.
However, these two heavyweight organizations represent more than 30% of doctors in each of their categories, and without them, the draft agreement submitted at the end of last week by Health Insurance cannot succeed. Especially since this firm opposition is shared by the Union of Liberal Physicians (SML), which on Monday denounced an “anti-liberal” proposal, and by the French Union for Free Medicine (UFML), which declared against this draft agreement “from the start of the negotiations”, recalled its president, Dr Jérôme Marty.
“We are missing an opportunity to improve the care of our fellow citizens”, for his part estimated François Braun, judging that “the unions of doctors are not responsible”. A statement that annoyed Dr. Marty: “When the Minister says that the unions are irresponsible, it is because he judges that the doctors for whom he is responsible are irresponsible, which is scandalous. It was the government that missed out on this negotiation and this defeat is to be put in Macron’s buttonhole. We are liberals who already work 55 hours a week, we really want to do our part, but we already don’t have the time to meet the needs of all our patients, so we are being asked to see even more. However, we do not want to do shitty medicine by only seeing them for five minutes. If the government wants a reform worthy of the name, it must seriously review its copy. »
What will happen if there is no agreement?
No agreement should be concluded before this Tuesday evening. In which case, it will be necessary to go through the arbitration box to draw up a new agreement. “The parties involved in the negotiations appointed an arbitrator upstream, Annick Morel, former president of the High Council for the Future of Health Insurance, who has three months to hear all the protagonists and propose to the Minister an arbitration settlement which will be equivalent to an agreement. for the next five years, ”said François Braun’s entourage on Monday.
In this context, the envelope allocated to this agreement should be revised downwards: “the Minister will not want to give the same thing as in the context of a signed agreement”, we still confide, from side of the ministry. Enough to cringe on the side of the doctors’ unions, some of which are now waving the threat of a deconvention which would allow them to freely set their prices, “but without their care being reimbursed to patients by the Social Security”, we remind the ministry. A practice which currently concerns “a little less than 1%” of practitioners.
It will be necessary to wait until the end of May to discover the content of the draft agreement submitted by the arbitrator to the Minister of Health, who, after a period of a few weeks, will validate it… or not. “In case of validation, it will take a period of six months for the entry into force of any measure involving a financial revaluation, specifies the entourage of the minister. If the proposed arbitration does not lead to a new text, it is the old agreement that will continue to apply, but it is estimated that the arbitration settlement will succeed”.