White coats see red. This Thursday, the union of general practitioners (MG France) stepped up to the plate against Medicare, in a vitriolic press release. Professionals are engaged in a tug of war with the authorities, who accuse some of them of providing too many work stoppages to their patients. “The letters threatening to set targets for prescriptions of daily allowances (MSO) are beginning to rain down on general practitioners” denounces the union, which deplores the “threatening tone” of the letters sent by Medicare.
At the origin of the conflict are the controls of the rate of daily allowances issued by each doctor. These are carried out by Medicare, which also monitors drug prescriptions. Thanks to a fine statistical work, the administration identifies the practitioners whose prescriptions are considered abnormal, that is “those who prescribe 5 to 10 times more than the national average”, she explains to Figaro. Pinned professionals expose themselves to a procedure of potential “setting under objectives” which enjoins them to lower and justify their work stoppages issued, under penalty of financial penalties of up to 9000 euros.
While this procedural framework has existed for about ten years, a new control campaign was launched a few weeks ago. Only 1,000 professionals, i.e. nearly 2% of doctors, are targeted by Health Insurance: these are practitioners prescribing at least twice as many work stoppages per active patient (of working age) as their colleagues of the same territory, taking into account the structure of the patient base. 30% of general practitioners will receive a visit from a representative of their primary health insurance fund to guide them in their prescriptions.
Among professionals, this campaign does not pass. General practitioner in rural areas, Florence * was pinned down a few days ago. “I received a call from the Primary Health Insurance Fund by my department saying to me: ‘Here you are, you are a bad doctor, you are prescribing too many daily allowances, you are being placed under a target,'” he explains. -She. She then received a registered letter, inviting her to explain herself. “If you accept the setting under objective, you are tracked for three years, to justify each stoppage of work”, underlines the one who has already been the subject of a similar procedure a few years ago. “I do not prescribe abusively”, however assures the practitioner. “I happen to consult in an agricultural environment, where long-term illnesses and work accidents are extremely frequent,” she defends.
This time, Florence will not accept her goal setting. His union, the Federation of Doctors of France, encourages professionals to refuse reinforced control, as does the Union of Liberal Doctors (SML) and MG France. The organizations are unanimous in denouncing the process. “It’s a real witch hunt,” warns Sophie Bauer, president of the SML, before arguing that the reproach addressed to doctors is a statistical offence. “Their only fault of these doctors is walking away from the curve. Medicine is not statistics, tance the union representative. Same story for Agnès Giannotti, president of MG France. “Doctors are directly targeted, without dialogue, without consultation with the profession,” she laments. Like Sophie Bauer, she would have liked “pedagogy” and “explanations” rather than “threats”.
Health professionals also agree on the “bad timing” of this control campaign. “The profession is already heated,” warns Sophie Bauer. The examination, at the beginning of the week, of the Valletoux bill revived the specter of a regulation of the freedom of installation of general practitioners. The latter were also unsuccessful in their request for a price increase. The health insurance control campaign is therefore seen as yet another “blowball” for the profession. “Especially since it is mainly young doctors who are targeted and who come to ask us for help”, adds the president of the SML, who says she is “worried about the future”. “More and more young GPs put on target tell me that they are going to leave at the end of the year,” she reveals.
For its part, Health Insurance emphasizes that this is not a new campaign but the first post-Covid campaign, “which may explain the surprise of the doctors”. It also highlights the details of the procedure, recalling that upon receipt of the letter from Health Insurance, “doctors have one month to submit their written observations or ask to be heard”, evoking “an essential contradictory phase “. Thus, in view of the deadlines granted, “the setting under objectives will only be effective from September 1st”. Not right away, then. According to the national fund, young doctors would not be more concerned than others by the procedure.
“Doctors are victims of the hunt for fraud by the State, as if we were the fraudsters”, is indignant however Marcel Garrigou Granchamp, union representative of the FMF. Health Insurance does not hide its concern about the increase in daily allowances. “In 2022, daily allowances represented 14 billion euros of expenditure for the State, excluding Covid. This is 6% more than in 2019”, notes the fund.
A dynamic corroborated by the provident institutions which, in a press release published Thursday, are worried about “a structural drift in work stoppages”. Contributions “provident”, which cover compensation needs related to work stoppages, increased by 9.3% compared to last year. “Of course there is an increase,” admits Agnès Giannotti. “But we did not change our practices overnight. It is the population that has changed, due to the evolution of society, the aging of the population, the decline in the retirement age…”, she adds, before wondering: ” Is it the population that is targeted or the doctors?
*Name changed
