2023-10-16 19:47:55
Rarely has a “framework letter” – this document emanating from the Ministry of Health, which marks the start of conventional negotiations between Health Insurance and private doctors – given rise to so many convolutions. While city medicine engaged, on Friday October 13, in a continuing movement to close practices at the call of all the unions and organizations in the sector, Aurélien Rousseau has been trying for several days to regain control.
The Minister of Health must, on Tuesday, October 17, send the famous missive to the Director General of Health Insurance, Thomas Fatôme, following weeks spent promising to send it. This short text is built around four axes, those around him specify, and above all establishes the desire to reconnect with a profession burned by the failure of the previous conventional round, in February. The inter-union of liberal doctors has decided to continue the strike movement, while waiting to read the letter.
Just a year ago, the previous framework letter set out an ambition: to fight once morest inequalities in access to health and once morest growing medical deserts. This ambition remains the same. But at the time it was a question of “counterparts” requested to doctors, even before discussions began. “Rights and duties”according to the expression of the then Minister of Health, François Braun.
Savings lever
The tone has changed. The context is eruptive, while the draft Social Security budget provides for 3.5 billion savings on health spending which continues to increase, and which has already been denounced as insufficient. The hospital federations of France called on the government on Monday October 16 to alert them to the 1.5 billion euros missing, according to them, from the credits planned for 2024.
The first axis of the framework letter concerns measures to make private medicine attractive. Remuneration, quality of life at work, entry into the career, mixed activity… These points will be one of the central issues of the discussion supposed to lead to a contract fixing for five years the conditions of exercise and remuneration of the entire profession.
Second direction set by the Ministry of Health: the “relevance and quality of care”. This technical expression covers the delicate question of ” responsibility [des médecins] in the prescription of sick leave and medication ». This savings lever, identified in the spring by the Ministry of the Economy and Finance, has already caused an outcry among doctors.
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