Targeted by a campaign of health insurance checks for having prescribed “too many” work stoppages, several general practitioners are protesting against “unfair, purely statistical procedures”. They believe that their difficult working conditions and the delays in accessing care are not taken into account.
20 minutes takes stock of the situation as, according to our colleagues from franceinfoHealth Insurance contacted this summer “5,000 doctors identified as important prescribers of work stoppages, in order to lift the veil on possible abuses”.
What are these health insurance checks?
Doctors who are too generous, who issue sick leave in an “atypical” way, are particularly targeted. Since June, these doctors have been summoned to explain themselves, and may be forced to lower their prescriptions. Interviews with consulting practitioners will be offered to the 10% of doctors who are in the bracket just above the 1.5% most prescribers
The doctors concerned receive “a call from Health Insurance”, sometimes presented “as a brotherly exchange”. Then a recommended “anxiogenic”, according to them, suggesting a “setting under objectives” (MSO) quantified, to reduce the volume of sick leave prescribed under penalty of a fine, tell the six doctors interviewed by AFP, preferring to remain anonymous . Health Insurance criticizes these practitioners for having prescribed two to four times more daily allowances (IJ) than the regional average in “similar municipalities”. More than a thousand doctors are targeted by the same procedure this summer, according to Social Security, they would be 5,000 according to franceinfo.
Why are work stoppages in Bercy’s sights?
In 2022, 8.8 million work stoppages were prescribed in France. Expenditure on daily allowances reached 13.5 billion euros (excluding maternity) that year, an average annual increase of 3.8% since 2010 [plus de 40 % en dix ans].
“There are people who abuse it,” said Economy Minister Bruno Le Maire in June, calling for “empowerment” of patients, employers and doctors. Sick leave, “it’s like antibiotics, it’s not systematic,” explained Renaissance MP Stéphanie Rist on Wednesday. on franceinfo. “When you need rest, it’s vacation or RTT, but not sick leave”, further advanced the rheumatologist. A general rapporteur of the Social Affairs Commission of the National Assembly who pleads that the “debate does not relate only to the minority of judgments of convenience”.
Professionals point to statistics “disconnected from the field”. “I have the misfortune to practice near large companies. My patient suffers from musculoskeletal disorders, recurrent tendonitis. These people work on the assembly line, in the food industry, they have no solution”. “Who stops them? Always me”, illustrates Doctor B., a forty-year-old living in Brittany.
What are the reactions?
“Doctors can and must” refuse the setting under objectives, hammer the trade unionists, including Marcel Garrigou-Grandchamp, head of the legal unit of the FMF (Federation of Doctors of France). Health insurance can then impose another procedure, consisting of “having each judgment validated one by one by the medical advisers of the Social Security”. “Unmanageable” on a large scale, assures the trade unionist. The FMF sometimes accompanies doctors in court. “We win” because “no patient is really comparable” with the average.
In June, while Health Insurance launched its hunt for sick leave of convenience, the president of the “general practitioners” branch of the Confederation of French Medical Unions (CSMF) assured that “putting this pressure on treating doctors” was “scandalous “. “It’s mistreatment vis-à-vis family doctors,” then launched Luc Duquesnel to AFP.
“It deeply affected me,” still moved Doctor B., a forty-year-old living in Brittany. “I feel infantilized, designated as the bad student, who does her job badly”, while “I have been practicing for fifteen years, with passion”. “I was asked to reduce by 15-20%. It’s impossible. The person with the gunned knee, it is not understandable to say to him: “sorry, it is the 20th of the month, I have reached my rate of IJ, go back to work”, he is moved. Now, as soon as I stop a patient, I have the impression of having the noose around my neck, and of continuing to tighten”. A colleague from the Parisian suburbs also points to medical desertification.
“Having an appointment for a scanner, an MRI, an operation, it takes months”, during which “everything falls on the general practitioner”, she testifies. “La Sécu tells me ‘it’s up to the psychiatrist to stop for depression’. But my patients can’t find them, or can’t afford them! “. “Worn out by three years of Covid-19, I work 80/90 hours a week. To be thus accused, monitored, it hurts, ”she still chokes.
What avenues are being considered?
On franceinfo, Stéphanie Rist said she wanted to work on the side of “health professionals, citizens and business leaders”, work stoppages being “often linked to musculoskeletal disorders”. The rheumatologist then pleads for “more prevention and adjustment of working conditions”.
While in the fall, the National Assembly will consider the Social Security financing bill, the MP also mentions several proposals concerning “short stops, the number of waiting days, the renewal of sick leave and “self-declaration during epidemics, for two days”.