The very principle of optional sector does not unanimously

After a full day of tough negotiations, they succeeded to agree to an attempt to limit exceedances of liberal physician, one of the main problems of the French health system. Health insurance, two unions of doctors (CSMF and SML) and complementary organizations (mutual, insurance and provident societies) reached a protocol of agreement last night.

The text provides for the establishment of a "optional said sector." Halfway between sector 1, where the doctors charge at the rate of social security, and the sector 2, where the fees are free, optional sector will allow limited overruns. The doctors who will join must achieve at least 30 of their actions at the rate of social security. For the rest, overruns must not exceed 50 of the paid tariff (said "against"). The Unocam, which brings together the complementary, is committed to a "large majority of the population covered" by a contract be reimbursed for these controlled overruns. Medicare will bear part of the social contributions of physicians for acts to the tariff set, as is the case for the sector 1 today.

The agreement concerns, first, only three categories of specialists in clinics and hospitals: surgeons, obstetricians-gynaecologists and anaesthetists. It is for them that the problem of overspending is the shouting (read below). Optional sector will be reserved for the practitioners of sector 2 and also a few hundreds of former heads of clinic in sector 1. They will have six months to choose whether or not to join the optional area. It will be open if it encounters a wide success from the outset to sector 2: sector 2 practitioners will need to be more numerous, among the préinscrits, the leaders of the sector 1 clinic.

The objective is that a "vast majority" practitioners free fees of three specialties concerned have left the area 2 in three years. Specifically, ensure that 55 of the surgeons practice enforceable or controlled rates to this horizon and 80 of anaesthetists - the objective for gynaecologists yet to be defined.

A control operation

This protocol agreement is historic to more than a title. For the first time, control of rates will be the fact of not only health insurance but also of the complementary intervention. For the first time, it would affect revenues from physicians without the rates of reimbursement of the acts.

The compromise reached between the different parties is not without risks. Some fear a windfall effect: sector 2 professionals who practice small overruns would have any interest in joining the optional sector, because this does not require them to change their practices. They would thus enjoy the benefits of the new sector, including the support of social security contributions, and it would not change absolutely nothing to the problem.

The very principle of optional sector does not unanimously. The CISS, which brings together about 30 patients associations, denounces "an operation of regularization of exceedances of fees" that will lead to "increase of 50 the consultations for the greatest number of users." And pricing "still complexifiée and opaque to our fellow citizens." A criticism made by MG France (GPS), which also says that the complementary is not obliged to support the overruns.