Question 17981 — health professions

Summary

Mr. Yves Daniel draws the attention of the Minister of Solidarity and Health to the issue of fee overruns. Currently, the setting of fees is governed by article R. 4127-53 of the public health code. This states that “The doctor's fees must be determined with tact and moderation, taking into account the regulations in force, the procedures provided or particular circumstances”. Gold too much numerous deviations are observed. In certain areas of the territory, particularly those where the cost of living is the highest, the differences in fee overruns vary greatly. Thus, they reach nearly 114% in Paris, 72.6% in the Rhône department and only 10.9% in the Cantal department. Rural areas also suffer to the extent that the number of doctors practicing at the sector 1 agreed rate is decreasing, creating inequality in the price and access to care. If the access to care contract, which entered into force in 2013 and replaced since January 1, 2017 by the OPTAM and OPTAM-CO devices for surgery and obstetrics, has made it possible to improve the situation (in fact, according to health insurance, the growth in fee overruns, all categories of sector 2 combined, went from 6.3% in 2000 to 2.5% in 2016), this decrease is essentially due to the increase in reimbursement bases. On the other hand, the increase in the amounts of these overruns continued. If general practitioners practice excess fees less than in the past, it is not the same for specialists: they are now 52.5% in 2016, compared to 30% in 1985. The highest rates of excess are found among medical gynecologists (98.2%), geriatricians (92.9%), neuro-psychiatrists (73.2%) and even stomatologists (72.1%). The entry into force of the access to care contract (CAS), in order to encourage practitioners to stabilize their excesses, and the “Optam” system, have had little effect. Thus, in 2017, according to the CNAM, the total amount of overruns reached the record level of more than 2.8 billion euros, including 2.65 billion for the only specialists. A figure up 6.6% compared to 2016. While health protection is enshrined in the preamble to the Constitution, and the first right of the sick person is to be able to access the care that their condition requires, whatever their income, a two-tier medicine is gradually establishing itself, favoring people who can assume excess fees at the expense of others. This is how a real divide is created in access to care, to the detriment of the poorest French people. At a time when citizens are demanding greater justice and equity, it is becoming urgent to take measures in favor of purchasing power by eliminating fee overruns while revising all medical pricing to the extent that certain procedures are underpaid while others are overpaid. He therefore asks him, on the one hand, what measures could be considered to eliminate fee overruns, and, on the other hand, how the Government plans to implement a review of the entire pricing of medical procedures in order to reduce inequalities in access to quality care in France.

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