The main representative unions, which have organized several days of strikes since the beginning of December, believe in particular that the price increase proposed by Social Security is far from sufficient.
The standoff that has lasted for several weeks between Medicare and liberal doctors is far from over. The six unions representing the sector (MG France, Avenir Spé, UFML, FMF, CSMF and SML) have until Tuesday evening February 28 to say whether they agree, or not, with the new fee schedule offered to them by Social Security for the next five years.
But several of them have already made their response public: they will not accept the new consultation tariffs proposed, which are much lower than their request for doubling the tariffs. “There won’t be a deal by Tuesday night, that’s pretty much certain,” has already regretted the Minister of Health, François Braun, Monday on France Inter. Franceinfo returns to the announced failure of these negotiations.
What does Medicare offer to meet the demands of doctors?
The new Social Security proposal for consultation rates, far removed from union demands since the beginning of December, is still at the heart of the disputes. The National Health Insurance Fund (Cnam) proposes that all medical consultations be revalued by 1.50 euro. An appointment with a general practitioner would for example go to 26.50 euros (compared to 25 euros since 2017) and that with a specialist to 31.50 euros (instead of 30 euros).
Another proposal: the possibility for a practitioner to increase the price of his consultations – for example from 25 to 30 euros for general practitioners – but on condition of respecting a “territorial commitment contract” which implies for example to see more patients , to participate in call duty or to consult on Saturdays.
To upgrade all of these subsidized consultations (therefore with reimbursement of the Social Security for the patient), Medicare provided for an annual envelope of 1.5 billion euros. In view of “colossal sums” in play, a “unconditional upgrade was not an option”, informed the minister’s entourage. Especially since “40% of doctors already meet the conditions” of the “territorial commitment contract” and might have benefited from the increase in the price of the consultation to 30 euros without working more, we are assured from the same source.
Why are the negotiations at an impasse?
The French Union for Free Medicine (UFML) or the Doctors for Tomorrow collective have been asking since the beginning of the movement of liberal doctors for a doubling of the basic consultation fee, from 25 to 50 euros. The conditioning of a revaluation of the consultation to 30 euros also made some of the attending physicians jump. On Sunday evening, the MG France union, the main representative of general practitioners, rejected “100%” this proposition. “The government has not understood the malaise of this profession, whose workforce is devastated, whose workload is increasing by the domino effect of successive departures (…) Medicare has not measured the lack of attractiveness of this complex medical specialty”, argues MG France in a press release.
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“This defeat is to be put in Mr. Macron’s buttonhole”, for his part reacted Jérôme Marty, president of the UFML, Monday on franceinfo. “Thousands of doctors (…) are beginning to look at deconvention as a solution”, he warns. This would mean that Medicare would no longer reimburse care from these practitioners. A threat “irresponsible”, lamented on franceinfo Thomas Fatôme, director general of the Cnam, while nearly 6 million French people do not currently have a doctor.
“It would not serve any cause, and especially not that of our fellow citizens”, do we condemn in the entourage of the Minister of Health, where it is estimated “less than 1%” doctors who are not currently contracted. Still according to his entourage, François Braun “regret” the refusal of the unions to the proposals of the Medicare and deplores that “doctors’ unions” have passed by “responsibility issues”.
What will happen now?
Unless there is a last-minute change, no agreement between Medicare and the liberal doctors will be signed by Tuesday evening. If this is the case, an “arbitrator” will set the new rates, following consulting all the parties. Annick Morel, former general inspector of social affairs, will have “three months to propose to the Minister of Health an arbitration settlement which will be worth an agreement with the doctors”, we explain in the entourage of François Braun. The Minister of Health will then have a three-week approval period. In the meantime, the consultation rates in force continue to apply.
