Mixed revision of the 2016 medical convention

A liberal doctor.

Medical deserts, preventive shift, treatment remuneration, digital health… Health insurance, Unocam and the liberal doctors’ unions start negotiations on the medical agreement on November 9th.

The complementary organizations represented by Unocam will be involved in the negotiations on the next medical convention that defines the framework for the exercise of the private medical profession for the period 2023-2028.

In a resolution adopted unanimously, Unocam writes that ” wants to be a constructive and useful partner in finding the most appropriate responses to the challenges of transforming the health system. This presupposes an in-depth dialogue between lenders to define and calibrate the mechanisms in which OCAMs could participate. A balance should definitely between the necessary investments and the new commitments undertaken by the profession, in a logic of rights and duties “. In parallel to the contractual negotiations, Unocam will also participate in the dialogue committee with complementary organizations, set up by François Braun, Minister of Health and Prevention.

The pace of the negotiations will be sustained as a text will have to be adopted by the end of March 2023. The main lines of the negotiations were established in a framework letter sent on 27 October by François Braun and Agnès Firmin Le Bodo, Minister Delegate and Head of Organization of the Territory and Health Professions.

4 negotiation topics

The first point of the negotiation will concern inequalities in access to health, be they territorial, social or financial “On this axis, the negotiations will focus on access to a treating doctor, on the management of extraordinary care, on territorial distribution or even on extra expenses.

The second axis will focus on ” the integration of prevention into medical activity, as well as the improvement of practices and the quality of care “. The third axis will aim at” free up medical time to allow doctors to increase their patient base “. The goal is to recruit 10,000 medical assistants by 2025. Finally, the last axis will concern” the means to implement an ambitious digital health roadmap “.

2016 Convention, objectives not achieved

In 2016, the previous medical agreement and its amendments set the framework for the activity of doctors for the past 7 years. In a note, the consulting firm Proxicare elaborates a mixed assessment on the effects of the previous medical convention.

This text raised the price of consultations to € 25 and created new prices for consultations for complex treatments. One of the aspects most criticized by the ocams was the creation of the patient’s doctor’s fee (FPMT) to enhance the coordination role, the amount of which is around 800 million euros. According to Proxicare’s calculations, ” the average amount of FPMT paid per general practitioner and per year in 2021 reached € 25,503 in addition to the fee per service, bringing the value of a general practitioner consultation corrected for the flat-rate remuneration (FPMT, ROSP, structure package, FSTR and other aid) and social security contributions of € 35.20 in 2021 “.

To promote the medical offer in the area, four so-called ” demographic »Were created to facilitate the establishment of doctors in subdense areas. Despite these efforts, 6.4 million French people do not have a general practitioner, an increase of 1.7 points compared to 2017.

Increased overtaking

To limit tariff overruns, the old healthcare access contract (CAS) was transformed. “optimal” And “Optam co”. The goal was to double the number of doctors who agree not to limit the overrun of tariffs, but the goal has not been achieved. If 10,000 doctors joined the CAS in 2014, that’s just 14,974 optam-optam-co members in 2021, according to Proxicare. The company also indicates an increase in the number of specialists charging overruns. They were 45% in 2016 and they are 50% at the end of 2020.

This development, combined with the limit to the coverage of overruns by complementary bodies under the responsible contract, automatically implies an increase in the residual to be borne by patients.

The agreement also introduces quotations in the nomenclature of reimbursable procedures for teleconsultations and tele-appraisals. An addendum also defines the support framework for telemedicine.

More recently, an amendment introduces aid to finance the hiring of medical assistants in order to free up medical time. Around 3,500 contracts were signed in 2022, according to Proxicare. Finally, the service of access to care (SAS) established with the modification allows to regulate the coverage of extraordinary care by private doctors on a territorial scale.

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