Question 13983 — health

Summary

Mr. Édouard Bénard draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the growing concern of health professionals and patients regarding the future of the Asalée system (liberal team health action) implemented by the association which bears the same name. Created in 2004, this network today relies on more than 2,000 nurses and 9,000 general practitioners across the entire national territory. These professionals play a central role in the management of chronic diseases, therapeutic education, early detection and prevention, particularly in areas where access to care is already limited. With continued growth since its creation, the Asalée network received more than 100 million euros last year from the national health insurance fund (Cnam). A sum which represents 98% of its resources. However, the Asalée system is today threatened due to the deterioration of relations between the management of the association which manages the system and the public authorities which finance it. Following the first alerts expressed in 2023, the Minister in charge of health and prevention entrusted a management control mission to the General Inspectorate of Social Affairs (IGAS) relating to the system Asalea. It made its report public (IGAS no. 2024-043R) on July 4, 2025. The report highlights several dysfunctions considered serious, concerning governance, financial management and compliance with public procurement rules. In the absence of a convincing response from the association's management to the recommendations made to it by IGAS, Cnam has decided to suspend its payments from the month of December 2025. In fact, the structure is today faced with a budgetary impasse and can no longer meet its financial commitments, in particular to remunerate health professionals carrying out missions under the system. In response to the Cnam, the president of the association sent an open letter at the end of January 2026 in which it states that "third parties have tried to attack the money intended for salaries, to create fear, of spreading rumors, of impressing, of weakening” while adding “that we do not manage health like an accounting line”. The president of Asalée declares in this same letter “that we do not manage care by pressuring those who make it possible, that we do not let uberization and financialization make professions more precarious, break up collectives, push back ethics, damage our social security solidarity”. Finally, it denounces chronic underfinancing and payment delays by the Cnam at the origin of a precautionary seizure carried out by Urssaf. On March 6, 2026, the health insurance company indicated that it had been informed of the referral to the Paris Economic Affairs Court for the purpose of opening a judicial recovery procedure for the Asalée association. If the fate of employees is of course worrying, the possible The disappearance of the Asalée network also raises serious concerns among the 9,000 general practitioners who are partners of the system. They fear a significant overload of their activity in the event of the association being completely shut down. For more than ten years, Asalée has demonstrated its effectiveness in improving the quality of care for chronic pathologies and in supporting general practitioners through optimization. medical time. Its action is particularly valuable in rural areas facing medical deserts. Beyond the grievances made on both sides which call for rigorous corrective measures, the preservation of the public interest missions carried out by the association appears essential in view of its usefulness recognized by health professionals and local elected officials. In view of these elements, it asks, on the one hand, to specify what measures the Government intends to take to guarantee the continuity of the activity of nurses employed by the Asalée association and the maintenance of their collaboration with general practitioners under lasting conditions and, on the other hand, what are the prospects for development envisaged to perpetuate the public utility missions of the Asalée association in order to ensure its continuity for the benefit of patients and healthcare professionals.

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