A decree and a decree published Thursday in the Official Journal wants to charge higher fees the mutual most excessive. But the solution does not convince everyone. The overshoot of fees of ophthalmologists in France reached 60% in 2010.
Stop abuse of excess fees. This is the objective of the government on Thursday issued a decree and a decree in the Official Gazette binding the complementary health to repay overruns capped fees of medical specialists. It also set up a sector "optional", in addition to the existing sector 1 and 2. What will it change?
The measure comes into immediate application and requires complementary health (mutual insurance companies, pension funds) to reimburse patients for excess fees capped at 50% above the rate Safely.
Are concerned overruns practiced by physicians in the operating room (surgeons, anesthetists, obstetricians) who are currently in "Area 2", that is to say, who are allowed to charge more for their patients that the rate paid by health insurance, unlike their colleagues in the majority, engaged in "an area".
These are practitioners who wish to opt for a new area, was called up to "optional AC" and now "option broader coordination". If they limit their exceedances Safely 50% discount for 70% of their technical procedures, health insurance will pay their social security contributions (health, retirement, etc …) about 30% of procedures they will costs continue to make enforceable.
In addition, these practitioners will know that their excesses will be capped and systematically reimbursed by complementary health of their patients, whereas currently they apply their own refund policy, more or less generous.
The decree signed by Prime Minister Francois Fillon forced health contracts known as "responsible", that is to say over 90% of those offered by complementary health, to include reimbursement for the excess capped.
The order, signed by Health Minister Xavier Bertrand, complete a medical article of the Convention signed in July 2011 by health insurance and union of general practitioners and 50% fixed the permitted block for practitioners choosing " the option of coordination ".
If they were released discreetly, these official documents have provoked many reactions, all very critical. Mutuality French, spearheaded the opposition to "optional AC", condemned the measure. Its chairman Stephen Caniard spoke of "an unreasonable obstinacy of the government."
In a joint statement, Mutuality and the seven unions (CGT, CFDT, CFTC, CFE-CGC, FSU, UNSA) "disagreed (…) and called for" resolute action against the excesses of fees ". "This device runs counter-productive because it does not interest the specialists who practice overtaking the most important as he is a windfall for others", says the text.
The UFC-Que Choisir develops similar arguments and evokes a "black Thursday for access to care of the French," saying that this will cause "a new automatic dues increase of complementary health."
The union of doctors, the Bloc, representing the specialists involved, the concern that not only practitioners of sector 2 are not interested, but those of a sector, whose rates are frozen for years decide to apply those of the option of coordination. In fact, most healthcare players think that a real solution to overflows through a tariff increase effective against a sector by health insurance.