Question 16827 — maternity health insurance

Summary

Mr. Hubert Ott 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 treatment not on the nature of the prescribed procedure or its medical indication, but solely on the conventional status of the prescriber. Thus, two patients with the same pathology and receiving the same prescription will not benefit from the same reimbursement depending on whether or not their doctor has signed an agreement with the CNAM. This difference in treatment is not based on any objective criteria linked to the quality or safety of care: 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. However, this measure penalizes patients throughout the national territory. In normally well-equipped areas, many doctors practicing in sector 1 and 2 are no longer accepting new patients or offering waiting times that are incompatible with current care needs. The sector 3 doctor then fulfills a function of access to care that the 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 commonly reach three weeks. Deprive these patients reimbursement of their prescriptions would amount to sanctioning 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 under-dense 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 qualified by the ARS as under-dense and 88% of them carry out an activity exclusively oriented towards care. In these territories, dereimbursement would constitute a double penalty: absence of local alternative and full coverage payable 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 of their prescriptions. The resulting foregoing of care and referrals to already saturated emergency services would be counterproductive both in health and budgetary terms. He asks how the Government intends to guarantee equal care for all insured persons 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.

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