2024-10-02 10:18:01
The medical biology laboratories lowered the curtain from September 20 to 23. Four days of strike called by seven unions* to protest against the continued reduction in the pricing of their actions. Update with Dr François Blanchecotte, president of the Union of Biologists (SDBIO).
Comments collected by Géraldine Bouton
How was the movement followed?
Dr François Blanchecotte: Massively! More than 96% of medical biology laboratories have closed their doors during these four days of strikeor 4100 sites out of 4300. This is the first time that we have had an almost total closure of the sites. The requisitions requested by some ARS were contested and were mostly unsuccessful.
What are your demands?
Dr F.B. : During the summer, Health Insurance decided, without consultation, to reduce the price of our procedures by 9%. A measure which took effect in mid-September and follows a series of reductions of 11% in total over the last two years. The agreement that sets our prices is based on a price/volume regulation mechanism. The price of the procedures drops when the expense exceeds the financial envelope defined by the agreement, signed in 2023. The latter is based on the reference turnover to which 0.4% per year is added for three years.
Since the start of the year, we have experienced a significant increase in biology exam prescriptions. The National Health Insurance Fund has therefore, unilaterally, proposed to reduce our prices.
We are the only ones to pay back money when the volume of procedures, prescribed by others than us, exceeds the set limit. Medical biology cannot thus finance the growing demand for healthcare from the French and prescribed biological examinations. Today, for example, we pay for part of the screening tests with our turnover. L’increase in these examinations essential to public health increases our examination volumes and, in fact, leads us to return money. Screening should be an out-of-envelope examination. The situation of laboratories is deteriorating. We need to review this agreement.
You are therefore contesting the three-year agreement which governs the evolution of your prices, signed a year ago. Why are you questioning it today?
Dr F.B. : The agreement is based on unshared estimates from the CNAM. When we signed it, we were not aware of the extraordinary increase in the volume of documents. If we had known, we would not have signed it. We have therefore decided to attack this agreement in summary proceedings, its publication in Official Journal and the modalities of voting in committees. Since August, we no longer participate in committee meetings.
Have you heard back from Health Insurance since this strike episode?
Dr F.B. : None. I had a quick exchange with the general director of the CNAM on September 20, on the sidelines of the 30th university of the Confederation of French Medical Unions. He stands his ground, believing that we have signed the agreement and that we must stick to it. Our recourse today is the judicial and political authorities, Parliament and, of course, our new Minister of Health.
What will happen now?
Dr F.B. : We are entering the second phase of the movement. We are going to meet elected officials, parliamentarians, ministerial advisors… The challenge is to show very concretely in the territories how things will change if we stay with this agreement.
All laboratories will in fact be affected by a drop in their turnover. We therefore ask them to display on site the consequences of these successive reductions on the opening hours to the public, staff recruitment, etc.
Finally, if nothing changes, the laboratories will remain closed as soon as we estimate that this would result in price reductions from January 2025. This “ shut down » seems to be the only way to make the authorities understand that we play a role with the 500,000 patients welcomed every day in our laboratories.
If you are not heard, do you really fear a deterioration in the provision of medical biology in the region?
Dr F.B. : The situation in rural areas worries us. With a low rate of prescribers, field laboratories do not benefit from the increase in prescriptions and endure price reductions. They will close in the afternoon, if not already, on Saturday, or even permanently.
THE inequalities will widen between urban and rural areas for access to care, rapid reporting…
Who will alert and set up support on a Friday evening by discovering anemia or worse in a child if the laboratories close? The delay in diagnosis is a real waste of opportunity. The decisions of the CNAM lead us towards a preindustrial biology while we wish it practitioner, medical and close to people.
Will independent laboratories be more affected than groups?
Dr F.B. : Several studies have been published in recent days. One shows that certain liberal companies would be in the red this year. Even if we can believe that the grouped companies could resist better, they will have to make decisions to reduce their costs to allow them to maintain margins to invest and meet their commitments. But, whatever happens, there will be implications for patients.
*SNMB, Biomed, FNSPBHU, SNBH, SDBIO, SLBC, SNMB-CHU.
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