Question 15532 — maternity health insurance

Summary

Ms. Marie-Agnès Poussier-Winsback draws the attention of the Minister of Health, Families, Autonomy and People with Disabilities to the consequences of article 76 of the social security financing law for 2026, which provides, from January 1, 2027, for the dereimbursement by the National Health Insurance Fund (CNAM) of health products, procedures and services established by doctors practicing in sector 3. This provision conditions care not on the nature of the prescribed procedure or its medical indication, but solely on the conventional status of the prescriber, while all doctors, whether or not they are approved, are subject to the same ethical obligations and the same freedom of prescription guaranteed by article L. 162-2 of the social security code and articles R. 4127-8 and R. 4127-53 of the public health code. So, two Patients with the same pathology and receiving the same prescription will not benefit from the same reimbursement. In normally well-equipped areas, many doctors practicing in sector 1 and 2 no longer accept new patients or offer waiting times that are incompatible with current care needs. The sector 3 doctor then fulfills a function of access to care that ARS zoning does not record: more than 54% of non-contracted doctors thus receive their patients in less than 48 hours, where waiting times in sector 1 or 2 are longer. Depriving these patients of reimbursement for their prescriptions would amount to penalizing them for using the only practitioner actually available, regardless of the administrative classification of their territory. This reality is even more acute in areas officially recognized as subdense by the ARS. According to data from the Ameli file and the work of the sector 3 doctors' union, 56.7% of the 1,126 non-contracted doctors practice in areas classified by the ARS as under-dense and 88% of them carry out an activity exclusively oriented towards care. In these territories, delisting would constitute a double penalty: lack of local alternative and full coverage at the borne by the patient, including for medications or examinations covered by common reimbursement law. In total, more than a million patients would be deprived of reimbursement for their prescriptions. The resulting foregoing of care and referrals to already saturated emergency services would be counterproductive both in health and budgetary terms. She wishes to know how the Government intends to guarantee equality of support for all policyholders and continuity of access to care throughout the country from January 1, 2027, the date on which the measure will come into force.

Machine translation from French. The official text remains authoritative.

Timeline

No timeline events have been ingested for this record yet.

Votes

No vote records are attached yet.

Versions

No version snapshots stored. Document URLs remain at the source.

Documents

No documents linked.

Sponsors

No sponsors or actors listed by the source.

Related records

No cross-record relationships stored yet.