PoliticalRepoPoliticalRepo

Person

Jean-Pierre Door

France

Records

34 records where Jean-Pierre Door is listed as a sponsor, author, or other actor. Search with topics and years

Question· Question écrite8729answered

Question 8729 — diseases

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to prostate cancer with bone metastases. Prostate cancer ranks first among cancers in men and represents the third cause of death from tumors in men in France. It kills more than 8,300 patients per year in France, 2,600 of whom suffer from bone metastases, or more than 50 deaths per week! But a solution exists but is still not offered to French patients, while this has been the case in the rest of Europe since 2013. In fact, radium 223 dichloride (known under the name Xovigo) is the first emitter of alfa particles which target bone metastases. Currently, Xovigo is prescribed and supported in 27 countries, including 23 in Europe. In Germany, it has benefited 3,641 patients since 2013 (i.e., in 216, 1,313 patients). In In England in 2016, there were 988 patients, 327 in Spain, 356 in the Netherlands and 456 in Italy who were treated. In France, only 64 patients were able to benefit from this treatment. He therefore asks what measures the Government intends to take to urgently authorize the coverage of this treatment in France.

Question· Question écrite8638open

Question 8638 — veterans and victims of war

France · National Assembly

The Secretary of State to the Minister of the Armed Forces would first like to point out that in view of the regulations in force, the distinction “Death for France” can only be awarded to people whose cause of death is the direct consequence of an act of war. This statement constitutes a provision relating to civil status and is therefore included in the margin of the death certificate of the persons concerned. The attribution of the mention “ Death for France” has the particular effect of making it obligatory to register the name of the deceased on the war memorial in their commune of birth or last domicile. The victim's minor children are also eligible to be adopted by the nation. When, for whatever reason, the words “Death for France” could not be entered on the death certificate at the time it was drawn up, it is added. subsequently as soon as the circumstances and necessary elements of justification permit. The name “Death in commanded air service” aims to honor the memory of aviators who died on mission as a result of an air accident. There is nothing to prevent the persons concerned from benefiting from the attribution of the designation “Death for France” in the event that they meet the required conditions. recalled above.

Question· Question écrite42000open

Question 42000 — health professions

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the delay in the answers he wishes to obtain to the written questions he addressed to the Government. He thus wishes to draw the attention of the Minister to the definition of people authorized to carry out vestibular rehabilitation. Vestibular rehabilitation is a sensory balance rehabilitation that uses the interaction between vision, the organ of the balance located in the inner ear, the mechanical sensors of the muscles of the spinal column and the feet. Today it constitutes a very widely recognized specialization of physiotherapy and it is widely practiced, including in hospitals because it is based on incontestable scientific data. Vestibular physiotherapy occupies a specific place in the therapeutic arsenal against dizziness and balance and walking disorders. It aims in fact to correct three categories of disorder: a postural, proprioceptive or neuro-visual disorder. However, certain paramedical professionals, under cover of authorization to perform neurosensory assessments, practice vestibular physiotherapy, outside of any legislative or regulatory framework. Thus, certain orthoptists whose function is to detect, analyze and to treat visual disorders, competent in vestibulo-visual rehabilitation, are expanding their interventions by practicing the rehabilitation of patients suffering from a vestibular disorder in the broad sense of the term. Today the exercise of vestibular rehabilitation is much broader than originally. The method has become a rehabilitative specialty, with the implementation of an increasingly codified precise clinical examination, a diagnosis of vestibular function which includes an otoneurological, neurological and musculoskeletal assessment, as well as specific treatment procedures. The MP asks the Minister why health insurance covers a higher cost of the neurosensory assessment when it is carried out by an orthoptist rather than by a vestibular physiotherapist, the only one legally authorized to practice it. He therefore also asks why vestibular rehabilitation procedures also carried out by other professionals outside the general nomenclature of professional procedures are reimbursed by health insurance. Finally, he asks if there are plans to better delimit and adapt, to articles R. 4321-5 et seq. of the public health code, the scope of competence of the vestibular physiotherapist.

Question· Question écrite41950open

Question 41950 — higher education

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the lack of financial support for students affected by serious illnesses which can in certain cases lead to the death of the individual. Every year, many students are struck by serious illnesses which prevent them from being able to complete their school career. They benefit from medical monitoring but do not benefit from support responsibility for health costs. In fact, a student suffering from an illness does not receive any daily allowance unless the student is on a work-study program and the company agrees to provide compensation. All costs are the responsibility of the family. In addition, the family is not entitled to any material assistance to facilitate their child's daily life during this period and to no psychological support. Lack of help at home to relieve those close to the patient is also insufficient. Faced with this situation, it is urgent to question the role of social services in supporting families and to set up a one-stop shop to which families can contact. He asks him if the Government plans to put in place economic and material support measures for these students in order to allow them to be supported. adapted to their illness.

Question· Question écrite39004answered

Question 39004 — pharmacy and medications

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the effectiveness of maintaining a national security stock of medicines entrusted to pharmaceutical laboratories in response to the increase in situations of shortage or tension in the supply of medicines and vaccines. Difficulties or shortages relating to drugs of major therapeutic interest may lead to interruption or postponement of life-saving treatment. More generally, each patient must be able to access the medications they need and within the time frame they expect. During the sars-cov 2 epidemic, the Government was alerted on several occasions to the major risks of a shortage of essential drugs for the care of patients with covid-19. In the fall of 2019, Parliament voted for the obligation of holders marketing authorization and drug operators to constitute a safety stock intended for the national market, located on French or Community territory. In fact, the purpose of article 48 of the social security financing law for 2020 was to combat the risks of disruptions in the supply of medicines, which have been increasing sharply over the past ten years. But this new obligation was not not come into force until the publication of Decree No. 2021-349 of March 30, 2021, which has just specified the applicable terms, from September 1, 2021. Thus, marketing authorization holders and companies operating a medicine must constitute a safety stock of medicines intended for the national market with a maximum duration of four months to cover drug needs. The decree defines a minimum storage period of at least two months for medicines of major therapeutic interest and at least one week for other medicines. The precedent of the disengagement of the State, due to the delegation to the responsibility of each employer of the mission of safety storage of masks for protection of personnel and the disappearance of the industrial sector of production of masks, must however invite the caution. It therefore asks it to specify how it intends to ensure clear and transparent information on the causes and history of these shortages and the plans for managing drug shortages. He therefore asks him if there are plans to place under the Prime Minister a national body for managing supply disruptions responsible for defining a national strategy for the prevention and resolution of the causes of supply disruptions. supply disruptions which are in fact multiple. He asks how stocks of drugs of major therapeutic interest will be constituted given the number of specialties concerned and the quality standards associated with the management of these stocks. Given the high concentration of drug production sites located over long distances and the length of distribution chains, while prices of drugs among the lowest, he questions him about the reality of a system for controlling safety stocks of drugs located outside the national territory. In the event of a global shortage of medicines and a concomitant reduction in air transport, how is it planned to transport these stocks to the national territory? Finally, he asks how the Government intends to find an industrial and health strategy and relocalize the production of drugs considered strategic.

Question· Question écrite38331open

Question 38331 — elderly people

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister Delegate to the Minister of Solidarity and Health, responsible for autonomy, to the low vaccination coverage of the elderly, particularly with regard to pneumococcal vaccination. The covid-19 pandemic has been a strong reminder of the significant consequences that infectious diseases can have on people over 65 years old. Several factors explain the particular exposure of the elderly to the risk of infection, such as immunosenescence or the presence of comorbidities. Thus, high age is a risk factor for invasive pneumococcal infection. Given the aging of the population - in 2040, 11 million French people will be 75 years old or over, or 15% of the population - and the increasing prevalence of chronic diseases - in 2018, 43% of those over 65 living in home had at least one long-term illness, i.e. 5.6 million people, the prevention of the risk of infection must be the subject of particular attention. Faced with this major challenge, several infections can already be prevented today by vaccination. In the epidemic context marked by the coexistence of viruses (SARS COV-2, influenza, pneumococcus), the Covid-19 Scientific Council recommended, from the month of July 2020, to combine these three vaccinations in order to best protect vulnerable populations. Indeed, the pathogens covid-19, influenza and pneumococcus act synergistically (same populations at risk), it is necessary to align and associate these vaccination policies more closely. On the other hand, elderly people form a population at risk which requires specific and adapted monitoring, particularly in the field of prevention. In order to prevent potentially serious infectious diseases, health authorities have developed a specific and reinforced vaccination schedule for people over 65 years of age. But this does not include pneumococcal vaccination, which is only recommended for vulnerable people (immunocompromised patients and patients with chronic diseases). However, age is a proven risk factor by increasing the probability of invasive pneumococcal infection. He therefore asks her if she plans to strengthen the prevention route through vaccination by extending the pneumococcal vaccine recommendation to all people over 65, as is the case in several countries (United Kingdom, Italy, Germany). He also asks her if she is considering implementing this consolidated course as part of a prevention meeting at the time of retirement.

Question· Question écrite37291open

Question 37291 — health professions

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the definition of people authorized to carry out vestibular rehabilitation. Vestibular rehabilitation is a sensory balance rehabilitation that uses the interaction between vision, the balance organ located in the inner ear, the mechanical sensors of the muscles of the spinal column and the feet. Today it constitutes a very widely recognized specialization of physiotherapy and it is widely practiced, including in hospitals because it is based on incontestable scientific data. Vestibular physiotherapy occupies a specific place in the therapeutic arsenal against dizziness and balance and walking disorders. It aims in fact to correct three categories of disorder: a postural, proprioceptive or neuro-visual. However, certain paramedical professionals, under cover of authorization to perform neurosensory assessments, practice vestibular physiotherapy, outside of any legislative or regulatory framework. Thus certain orthoptists whose function is to detect, analyze and treat visual disorders, competent in vestibulo-visual rehabilitation, broaden their interventions by practicing the rehabilitation of patients suffering from a vestibular disorder in the broad sense of the term. Today the exercise of vestibular rehabilitation is much broader than originally. The method has become a rehabilitation specialty, with the implementation of a precise clinical examination that is increasingly codified, a diagnosis of vestibular function which integrates an otoneurological, neurological and musculoskeletal assessment, as well as treatment procedures. specific. He asks why health insurance covers a higher cost of the neurosensory assessment, when it is carried out by an orthoptist rather than by a vestibular physiotherapist, the only one legally authorized to practice it. He therefore also asks why vestibular rehabilitation procedures also practiced by other professionals outside the general nomenclature of professional procedures are reimbursed by health insurance. Finally, he asks if there are plans to better delimit and adapt, to articles R. 4321-5 et seq. of the public health code, the scope of competence of the vestibular physiotherapist.

Question· Question écrite25532answered

Question 25532 — health professions

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Higher Education, Research and Innovation to the progress of the reform of access to studies and training of psychomotor therapists. In fact, training as a psychomotor therapist is currently accessible through a competitive examination reserved for holders of a baccalaureate and is prepared after three years in school. It is certified by the state diploma of psychomotor therapist. However, in 2018, the Government presented a so-called universityization project consisting of a progressive integration of health and paramedical training (nursing, physiotherapy, occupational therapy, speech therapy, psychomotor skills, etc.) at universities. The Ministry of Higher Education has decided to integrate psychomotor training institutes (IFP) and candidates for psychomotor studies into the platform from 2020. Parcoursup orientation as well as the elimination of the entrance exam to psychomotor school. The written and oral tests will thus be replaced by a selection on file. Due to the absence of real consultation with professionals, and the concern expressed by them and by candidates for psychomotor therapist training, he asks for details on the management of the hasty transition at the start of 2020 of a system to another. He also asks him to be informed on the modalities of the future admission system, the quality of the selection for entry into the first year, the duration of studies and the “re-engineering” of the training in order to better adapt it to the current patient base of the psychomotor therapist.

Question· Question écrite25510open

Question 25510 — pharmacy and medications

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the implementation of article 66 paragraph I. of Law No. 2018-1203 of December 22, 2018 on the financing of social security for 2019, which provides for the creation of a register of hybrid medicines and extends the right of pharmacists to substitute these hybrid medicines. The concept of hybrid specialty is covered in French law in the framework regulatory framework of the abbreviated procedure for obtaining a marketing authorization (AMM), this abbreviated procedure being a transposition, at national level, of the abbreviated procedure provided for in Article 10 of Directive 2001/83 EC establishing a Community code relating to medicinal products for human use. The demonstration of the effectiveness of a hybrid specialty cannot be done by bioequivalence studies as for the specialty generic. In this context, the National Agency for the Safety of Medicines and Health Products (ANSM) has already granted hybrid marketing authorization to certain medicines in an abbreviated procedure, with excipient compositions different from the reference specialty, without any formal clinical study of the medicine concerned, on the basis of a simple reference to clinical studies carried out on other products. Decree no. 2019-1192 of November 19, 2019 relating to the directory of generics, the register of hybrid groups and the abolition of the anti-tobacco fund defines the modalities for developing the register of hybrid groups and the procedures for registration and deletion of hybrid specialties and specialties referenced in this register. It entrusts the ANSM with the mission of ruling on the therapeutic classes concerned, the molecules substitutes and the rules of substitutability of this new category of medicinal products under French law, mentioning the nature of the differences observed between the hybrid specialty and the reference specialties of the hybrid group observed. He would therefore like it to indicate precisely the guarantees provided, particularly in terms of method, to be certain that patients do not risk being substituted with products whose the equivalence of effectiveness has not been demonstrated clinically or may cause more or less serious adverse effects, particularly in the case of chronic treatment.

Question· Question écrite25189open

Question 25189 — supplementary insurance

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the scope of so-called responsible supplementary insurance contracts governed by Articles R. 871-1 et seq. of the Social Security Code. The main objective of these contracts is to make the patient responsible for their health expenses by encouraging them to respect the coordinated care pathway. The regulations require contracts of supplementary health insurers, subject to compliance by the insured with the coordinated care pathway, to reimburse a minimum basket of care and to respect minimum and maximum reimbursement levels. However, within the framework of health expenditure control policies, many health products or services are not or no longer reimbursed by compulsory health insurance even though they are part of pathways care. Also, he asks her if she encourages insurers to include in the care baskets these non-reimbursable health products and services contributing to the proper use of care, within the framework of these responsible contracts.

Question· Question écrite21760answered

Question 21760 — civil servants and public agents

France · National Assembly

Mr. Jean-Pierre Door questions the Minister of Action and Public Accounts on the number of civil servants of all categories without assignment and underemployed for a prolonged period as well as on the overall annual cost which results for the State budget in terms of salaries and retirement pensions, year by year since 2012. He also requests an assessment of the situation of civil servants temporarily deprived of public service employment territorial which may give rise to lasting management by the management centers or the National Center of the Territorial Civil Service, as well as the cost for the employer and for these managing authorities. He also asks for details on the situation of itinerant or thematic ambassadors and their impact on public finances.

Question· Question écrite21553open

Question 21553 — diseases

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the solutions provided to the serious shortage of colorectal cancer screening tests affecting the entire French territory in 2019. Colorectal cancer remains the second deadliest cancer in France, with more than 18,000 deaths per year, as well as the third most common cancer and its incidence is increasing. However, if taken care of in time, it heals in 9 out of 10 cases. This is precisely the role of immunological tests to identify precancerous lesions to remove them before they develop into cancer. In fact, nearly 95% of colorectal cancers are diagnosed after the age of 50, in both men and women. This is why patients aged 50 and up to 74 can benefit from a colorectal cancer screening test as part of the program. national organized screening. However, several regions of France have been faced with a shortage of tests, resulting from the cancellation of the award by health insurance of a contract to designate the new supplier of screening tests. What could be considered a simple imbroglio has led to an overall shortage and an irremediable loss of opportunity for patients. Indeed, the earlier colorectal cancer is detected, the less extensive the treatments, the greater the chances of recovery. Delayed diagnosis therefore constitutes a major risk. With these shortages, nearly 16 million French people risk not being screened in time. Health insurance has assured that it is taking measures to distribute tests that may still remain in stock, after having identified them, to the most deprived regions. Also, he wants to know the results of the census and the result of the emergency measures taken in the first half of 2019 to ensure the continuity of a public health program and, on the other hand, how the Government intends to improve information on supply disruption situations and prevent such situations.

Question· Question écrite17371open

Question 17371 — pharmacy and medications

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the lack of equitable access to hospital innovations due to the additional criteria for inclusion on the list. In health establishments, the additional list allows coverage by health insurance of pharmaceutical specialties, for certain of their therapeutic indications, in addition to hospitalization rates, when these indications present an innovative character. This list, which is subject to regular updates, is established by order of the ministers responsible for health and social security and specifies only the indications concerned, in accordance with article L. 162-22-6 of the social security code. The inclusion of an innovative product on the list is additionally subject to its level of evaluation by the High Health Authority. This product must obtain, in more than its level of medical service rendered (SMR), a level of improvement in medical service rendered (ASMR). If they do not achieve this level of ASMR, they will not be registered or supported. Thus, the ASMR designed as an indicator to help set the price is diverted from its original objective, because it is used in the context of the list in addition as a criterion for access to reimbursement. Medicines reserved for hospital use and Innovators benefiting from a significant SMR are then refused their registration on this list, which deprives private patients of these innovations. This is therefore a break in equality compared to patients treated with products available in town for which only the SMR is a criterion for access to reimbursement. This worrying situation, which concerns in particular anti-cancer products, contravenes the cancer plan III of which one of the objectives aims to fight against inequalities and loss of opportunity for patients. He asks her how she intends to change the criteria of the list in addition to re-establish a fair situation of patient access to innovative products in the city and in hospitals.

Question· Question écrite17153open

Question 17153 — pensions: independent and special schemes

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the situation of chiropractors who have not been able to be affiliated to the Interprofessional Provident and Old Age Insurance Fund (CIPAV). Indeed, in the absence of legal recognition of the profession, the National Old Age Insurance Fund for Liberal Professions (CNAVPL) was opposed to this affiliation. Article 75 of Law No. 2002-303 of March 4 2002 relating to the rights of patients and the quality of the health system recognized the title of chiropractor. However, this recognition was only made effective nine years later by the publication of Decree No. 2011-32 of January 7, 2011 relating to the acts and conditions of practicing chiropractic and the decree of January 7, 2011 relating to the composition of the file and the terms of organization of the aptitude test and the adaptation course planned for chiropractors. In January 2012, new chiropractors were authorized to affiliate with the CIPAV. But the integration of the profession into the fund was only legalized by the social security financing law for 2018. Alongside the reform of social security for the self-employed, an overhaul of the CIPAV was introduced which includes, in fact, in its field of competence the profession of chiropractor. Due to state failure, some chiropractors do not meet the conditions for redeeming retirement quarters or points. He asks her what measures she intends to take as soon as possible, to allow regularization of the redemption of points and quarters of retirement and not further penalize the profession whose retirement situation is made unfair due to this state failure. He also asks whether these measures will be applicable to collaborating spouses.

Question· Question écrite16367answered

Question 16367 — health professions

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the crisis in the visual sector. Indeed, access to care in this area is not always guaranteed or involves excessively long waiting times. It would therefore be desirable to open up the possibility for orthoptists to renew and adapt optical corrections under the same conditions as those practiced by eyewear opticians. THE orthoptists, already authorized to carry out screenings, assessments and to take charge of rehabilitation, have in fact all the necessary skills in this regard. In the current state of the regulations, orthoptists can carry out a visual assessment as part of the renewal or adaptation of optical corrections. However, the prescribing doctor remains solely competent to write the prescription corresponding to the orthoptic diagnosis. This results in the mobilization of several health professionals, which involves numerous return trips and generates additional financial costs borne by the patient and Health Insurance. The reorganization of the visual sector would make it possible to relieve congestion in ophthalmology practices, reduce the cost of orthoptist consultations and promote prevention in visual health. This solution would have the merit to be compatible with the health system transformation plan “My health 2022” announced by the President of the Republic in November 2018 and to respond to the latest recommendations from the Court of Auditors. In its latest report on the application of social security financing laws, the Court clearly called for a change in the distribution of skills between the different players in the visual sector. and, more specifically, the granting of authorization for orthoptists to carry out visual assessments and simple consultations and to prescribe optical equipment. He asks her to clarify the Government's position on this extension of the skills exercised by orthoptists and whether she plans to introduce this measure of reorganization of the visual sector in the bill soon to be tabled in application of the plan. health.

Question· Question écrite16362answered

Question 16362 — health professions

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the lack of attractiveness of the orthoptist profession. This profession is accessible after university training attested by a certificate of ability as an orthoptist, the organization and content of which are set by a decree of October 20, 2014. This course provides for several weeks of internship during the six semesters of study. Internships can be principle be carried out in public or private hospital, medico-social, educational structures and in private practices. However, several points of the training grid have never been specified: the status of the independent training supervisor, the homogeneity of training throughout the territory, the means of controlling the authorizations of training places and the orientation of practical teaching. These uncertainties regulations have seriously penalized orthoptists. With particular regard to practical teaching, it appeared that internships in private practice were essentially devoted to assistance during ophthalmological consultations. Rehabilitation and rehabilitation missions, which nevertheless constitute the heart of the profession, found themselves marginalized, or even excluded from training. Orthoptics students now favor internships in ophthalmology practices, with better defined contours and accompanied by remuneration. During the debates relating to the social security financing bill for 2019, this difficulty was raised. It was linked to the ban provided for in paragraph 3 of article L. 4381-1 of the public health code, under the terms of which “The carrying out of these courses cannot have the aim or effect to increase the paid activity of these practitioners.” This provision was interpreted as prohibiting orthoptist students from carrying out internships with a privately practicing orthoptist. Several amendments were tabled to delete this paragraph. They were supported by the rapporteurs of the social affairs committee of the two assemblies. However, the Government opposed this deletion, considering that the provisions in question did not have the effect of prohibiting internships with independent orthoptists but only the invoicing of their interventions with patients. Paragraph 3 of Article L. 4381-1 of the Public Health Code therefore remained unchanged. Therefore, if the problem does not lie in this ban, he asks it to specify the measures it intends to adopt with a view to improving the content of the missions of internships in private practice, closer to the specificities of the profession and, in any case, how it plans to guarantee the sustainability and development of the orthoptist profession.

Question· Question écrite16292answered

Question 16292 — diseases

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Secretary of State to the Minister of Solidarity and Health to cervical cancer screening technologies reimbursed in France. Cervical cancer is a transmissible cancer which is characterized by a slow progression and the appearance of precancerous lesions that can be identified and cured well in advance. Responsible each year in France for the deaths of 1,100 women, it is one of the only cancers with a worsening prognosis. French patients currently only have access to two screening techniques. The first, the cervical smear (FCV), is the only one offered to all women even though it often leads to false positives and unnecessary surgeries. The second, the HPV DNA test, is reimbursed only to women for whom unidentified abnormalities are detected after smear (ASC-US). The latest technology, the HPV RNA test, while it offers the most effectiveness in identifying precursors likely to progress to invasive cancers, is not reimbursed in France. However, the HPV RNA test, which is not more expensive than the HPV DNA test, has had its reimbursement blocked since 2016 even though it is already widely covered in other European countries. Women's health should be a priority of the Government. By managing to reduce the proportion of women aged 18 to 24 carrying the viruses responsible for the disease from 23 to 1% in ten years, Australia is proving the effectiveness of a political will which is not limited to vaccination coverage. In the context of the launch of the national organized screening program for cervical cancer, it is feared that the effort to systematize an obsolete test has the opposite effect to that desired. He would therefore like to know whether the Government was considering recommending better screening techniques as part of the national organized screening programme. He questions in particular the possibility of financial coverage by health insurance for the HPV RNA test, in the same way as the HPV DNA test.

Question· Question écrite15174open

Question 15174 — maternity health insurance

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the dereimbursement of symptomatic treatments prescribed to people suffering from Alzheimer's disease or a related disease which came into force on August 1, 2018. Four medications can be prescribed to people suffering from Alzheimer's disease or a related disease. Taking these medications, combined with other methods of taking care, helps limit the impact of loss of autonomy and promote the well-being of the patient and those around them. Their dereimbursement has consequences, sometimes disastrous, for the people directly concerned. Families who can no longer afford such treatments notice, after stopping them, a precipitous worsening of the patients' cognitive and behavioral disorders. When they try to maintain the taking medication, families are then faced with a direct increase in their out-of-pocket costs of several hundred euros per year. In the absence of curative treatment and despite 100% coverage of the disease within the framework of the list of pathologies recognized as long-term conditions, 70% of the expenses incurred fall within the medico-social sector and are thus mainly borne by the families. The dereimbursement thus has the effect of putting in place a two-tier system of care. On the other hand, taking these treatments was until now a condition of access to clinical trials and thus represented an opportunity for all French patients to access innovative therapies. This decision therefore has a negative impact on the continuation of tests on potential new molecules and more. generally on national competitiveness. Faced with a difficulty affecting the daily lives of thousands of people in France, he asks what decisions the Government intends to take to sustainably improve the care of sick people and the support of their caregivers.

Question· Question écrite14383answered

Question 14383 — diseases

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the decision authorizing a new immunotherapy protocol for cases of metastatic melanoma. This is a treatment validated in August 2018, after a period of testing on numerous patients suffering from this form of cancer. The treatment, based on work in immunotherapy relating to checkpoint inhibitors which has just been rewarded with the 2018 Nobel Prize in Medicine, gave very encouraging results. However, currently doctors cannot apply this immunotherapy protocol in the absence of official publication of the decision authorizing them to implement it. Given the urgency of such treatment for patients suffering from metastatic melanoma and its challenge in terms of prevention, he asks under what deadline should be made official the decision authorizing the prescription of the new immunotherapy protocol in cases of metastatic melanoma.

Question· Question écrite14167open

Question 14167 — public procurement

France · National Assembly

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the situation of the Public Interest Group (GIP) Midi Picardie Hospital IT (MIPIH). This public inter-hospital cooperation structure specializing in the construction of the hospital information system has created two data centers and is an approved host of personal health data. He is a privileged interlocutor of public authorities and health establishments. The MIPIH counts among its members and clients hospital establishments in the public and private sectors spread throughout France. However, the regional audit chamber of Midi-Pyrénées underlined in 2013 the risks linked to the opening of the GIP to private individuals and highlighted dysfunctions showing that the group had often freed itself from the rules of public management. It criticized purchases made outside the rules of transparency and competition, even though the amounts of work or services purchased could be high. He asks him to what extent the operation of the GIP tends to become more professional and if the management now applies the provisions of Ordinance No. 2015-899 of July 23, 2015 relating to public procurement and Decree No. 2016-360 of March 25, 2016 relating to public procurement. He would also like to know the structural reforms undertaken by this important operator in the market for administrative management software for health establishments and whether a statutory clarification is envisaged. Finally, he asks for details on the consistency of its strategy in relation to that of the “My health 2022” plan, the ambition of which is to implement digital health governance and relying on digital technology to improve the organization of care and free up medical time.

Question· Question écrite40603open

Question 40603 — health professions

France · National Assembly · 7 March 2021

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the delocalized deployment of medical biology examinations on the basis of the provisions of article L. 6211-18 of the public health code, amended by article 67 of the social security financing law for 2020. The social security financing law for 2020 aims to specify the conditions for the deployment of medical biology delocalized which remains, in France, still very limited, due to lack of publication of the implementing decree. The health crisis has also accentuated the obstacles to this deployment, both legal and financial, in the face of a major and urgent public health issue. It is in fact necessary today to open up the field of application of delocalized medical biology. This involves expanding the list of eligible tests in alternative sites, when these tests are required by the health situation. Medical and paramedical professionals (doctors, pharmacists, nurses in particular) must be able to carry out delocalized medical biology tests, in their places of practice (practice, health home, pharmacy and medico-social establishment), in interprofessionality with medical biologists, in order to help streamline the care pathway. It is suitable thus to specify the practical conditions of these biological samples in the decree currently being drafted, for the purposes of applying article 67 of the social security financing law for 2020. It therefore wishes to know the orientations adopted by the Government in terms of the development of delocalized biology as well as the date of publication of this decree.

Question· Question écrite33805open

Question 33805 — pharmacy and medications

France · National Assembly · 10 October 2020

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the duration of delivery of contraceptive medications. The placing on the market of large packages of medications has become essential for chronic treatments, as well as for contraceptive medications, in order to allow the pharmacist to deliver the most economical packaging compatible with the information appearing on the prescription. If the Quarterly packaging appeared to be the most economical form, making it possible to avoid the additional cost of unused platelets when the patient stops her contraception, at a period when the cost of dispensing did not exceed 35% of the manufacturer's price excluding tax. Such packaging is no longer justified today for these treatments and no longer makes it possible to achieve this objective. Additionally, oral contraceptive medications benefit from a prescription regime whose execution is renewable for a period of one year and whose dispensation period has been extended to an additional 6 months. This duration applies to all contraceptive medications with the exception of those appearing on a list established by an order of the Minister responsible for health. This system, which aims to facilitate access to contraception and prevention of abortion, however, remains incomplete in that the execution of the prescription in maximum periods of three months considerably limits access to contraception for certain women, in particular the most socially fragile or the most territorially distant from a medical office and a pharmaceutical pharmacy, beyond the material constraint and the burden generated by this quarterly period. The periods of confinement as part of the covid-19 epidemic have accentuated for all women this lack of autonomy resulting from the packaging of platelets in too limited a number. He asks him if he plans to modify the limit on the duration of delivery of contraceptives currently set at 3 months in order to extend it to 6 months with a view to allowing the marketing and use of half-yearly packages.

Question· Question écrite34550answered

Question 34550 — professions and social activities

France · National Assembly · 11 January 2020

Mr. Jean-Pierre Door draws the attention of the Minister of Solidarity and Health to the situation with regard to the covid-19 bonus for home help employed directly by individuals or reporting to a mandated structure. In order to fully recognize the mobilization of professionals present on site during the covid-19 epidemic crisis, an exceptional tax-free and desocialized bonus was created by article 11 of the law No. 2020-473 of April 25, 2020 of amending finances for 2020. By decree No. 2020-711 of June 12, 2020, an exceptional bonus is paid to staff of public social and medico-social establishments and services of the hospital public service, the territorial civil service and the State civil service in the context of the epidemic. At the beginning of August 2020, the President of the Republic announced, like the nursing staff, the payment by Christmas of such a bonus to the 320,000 home helpers forgotten about the various financial aids and who worked during confinement. However, the allocation of the bonus concerns the staff of home help and support services and still leaves some forgotten. In fact, it does not apply to home help hired directly by individuals, most of whom are beneficiaries. of the personalized autonomy allowance and the disability compensation benefit or covered by a mandatary structure. However, these life assistants employed at home with elderly individuals and disabled people, who carry out the same work as those in the service providers, are entitled to the same recognition. There are thus some 900,000 employers over 70 years old or with disabilities who can, thanks to life assistants, overcome the harshness of periods of confinement. He asks him how soon he intends to remedy such injustice, especially since these professions suffer from a lack of attractiveness. He also asks him when he plans to involve representatives of the elderly and loss of autonomy professions in the reform of the financing of home services and in the preparation of the reform likely to realize the expectations of the creation of the fifth branch of social security.

Question· Question écrite16913open

Question 16913 — santé

France · National Assembly · 1 December 2019

M. Jean-Pierre Door appelle l'attention de Mme la ministre des solidarités et de la santé sur l'intérêt du développement de la pratique en cabinet dentaire de la sédation consciente intraveineuse. Celle-ci, réalisée en présence d'un médecin anesthésiste réanimateur, après une consultation diagnostic évaluant son indication, son niveau de risque et son niveau d'efficacité, permet au chirurgien-dentiste de prodiguer les soins dans des conditions optimales. La sédation en cabinet favorise ainsi la qualité des soins et permet d'obtenir de meilleurs résultats. Elle a pour avantage, du fait d'un geste indolore et amnésiant, d'offrir un accès aux soins à des patients à pathologie médicale lourde, en situation de handicap ou à perception phobique et dégradée du monde dentaire. Elle est, en outre, praticable dans de nombreux cas, notamment en chirurgie buccale et en implantologie. C'est enfin une procédure simple et accessible qui permet souvent d'éviter l'hospitalisation. La sédation est encadrée, légalisée et pratiquée dans les pays anglo-saxons et sur le continent nord-américain. Il convient de rappeler que la Société française d'anesthésie et de réanimation a déjà été sollicitée par le Conseil national de l'ordre des chirurgiens-dentistes sur la possibilité pour des médecins-anesthésistes réanimateurs de réaliser des sédations conscientes par voie veineuse dans les cabinets dentaires. Il lui demande en conséquence si elle envisage la possibilité pour des médecins anesthésistes réanimateurs de réaliser de telles sédations en cabinet pour des actes dentaires.

Question· Question écrite18706open

Question 18706 — professions de santé

France · National Assembly · 3 September 2019

M. Jean-Pierre Door appelle l'attention de Mme la ministre des solidarités et de la santé sur l'absence de statut du prothésiste dentaire. Le prothésiste dentaire participe et supervise la fabrication des différents types de dispositifs médicaux sur mesure (DMSM) à partir de la prescription fournie par le dentiste. Toutefois, en pratique, ils peuvent être appelés à la pose des attachements et des implants ainsi qu'au choix prothétique, des matériaux d'empreinte et des procédures d'implantologie adaptées au cas par cas. Il y a lieu en effet de souligner la nécessité de la coopération entre le cabinet dentaire et le laboratoire de prothèse dentaire. Il s'inquiète de l'essor des importations de prothèses ne répondant pas aux normes de qualité et des conséquences sur l'emploi. Les entreprises de prothèses dentaires sont de plus en plus confrontées à la concurrence à bas coût et aux importations alors qu'elles ont réalisé un effort d'investissement technologique dans la qualité des services prothétiques. Il l'interroge sur l'impact de la réforme du reste à charge (RAC) sur l'activité des laboratoires de prothèse dentaire alors que le choix a été fait du prix plutôt que celui de la qualité, et sur les risques d'une dentisterie à deux vitesses.

Question· Question écrite17535answered

Question 17535 — personnes handicapées

France · National Assembly · 2 May 2019

M. Jean-Pierre Door appelle l'attention de Mme la secrétaire d'État, auprès du Premier ministre, chargée des personnes handicapées, sur la situation des personnes reconnues en invalidité de catégorie 1 ou 2 par la sécurité sociale. Celles-ci sont capables d'exercer une activité professionnelle rémunérée avec une diminution de l'horaire de travail en raison de leur handicap. Cette possibilité de cumul a pour objectif une incitation à la reprise d'activité. Le cumul du salaire brut et de la pension d'invalidité ne doit toutefois pas dépasser le salaire dit de comparaison. Si le salaire de comparaison est dépassé pendant deux trimestres consécutifs, la pension d'invalidité est suspendue partiellement ou entièrement. Cette situation constitue un frein à toute possibilité d'évolution de carrière. Il lui demande par conséquent si elle envisage un assouplissement de cette règle dans le cas de versement de prime exceptionnelle et de prime d'ancienneté, ainsi que la possibilité d'un réajustement du salaire de comparaison.

Question· Question écrite24937open

Question 24937 — maladies

France · National Assembly · 11 March 2019

M. Jean-Pierre Door appelle l'attention de Mme la ministre des solidarités et de la santé sur la situation des personnes atteintes de troubles cognitifs et celle de l'accompagnement de leurs proches aidants. La prise en soins de ces personnes dépasse en effet trop souvent les capacités financières des familles concernées, ce qui ne leur permet pas d'assurer l'accompagnement de leur proche malade. Le nombre de personnes touchées en France par la maladie d'Alzheimer ou une maladie apparentée est estimé à 1,2 million, étant rappelé qu'une personne sur trois ne serait néanmoins pas diagnostiquée. Avec 225 000 nouveaux cas chaque année, la maladie d'Alzheimer est la plus fréquente des maladies neurodégénératives et pourrait toucher plus d'1,8 million de personnes d'ici 2050. Le nombre de personnes atteintes de ces maladies ne va cesser de croître sous l'effet combiné de l'allongement de l'espérance de vie, du vieillissement de la population et de l'augmentation du nombre de personnes atteintes d'une pathologie chronique. L'enjeu est de diagnostiquer la maladie dès ses premiers signes et de garantir et maintenir l'accès aux soins au sens large pour ces personnes afin d'éviter la perte de contact, l'isolement et la rupture dans l'accompagnement. Alors que le Plan maladies neurodégénératives (PMND) 2014-2019 touche à sa fin, il lui demande si elle compte en dresser un bilan officiel. Il lui demande en outre à quelles actions a été utilisé dans le Parcours Alzheimer le montant des sommes correspondant au déremboursement à compter du 1er août 2018 des molécules précédemment prescrites dans la prise en charge de la maladie d'Alzheimer. Il lui demande enfin si la nécessité d'un renforcement de l'accompagnement des personnes atteintes de troubles cognitifs sera prise en compte dans la future réforme « grand âge et autonomie » et selon quelles modalités le Gouvernement envisage dans les 5 ans à venir la mise en œuvre d'une nouvelle stratégie nationale de lutte contre la maladie d'Alzheimer et les maladies apparentées à la hauteur des enjeux.

Question· Question écrite24870open

Question 24870 — assurance maladie maternité

France · National Assembly · 11 March 2019

M. Jean-Pierre Door appelle l'attention de Mme la ministre des solidarités et de la santé sur le remboursement par l'assurance maladie des frais de transports en ambulance bariatrique. L'assurance maladie procède en principe à la prise en charge des frais de transport de l'assuré ou des ayants droit se trouvant dans l'obligation de se déplacer pour recevoir les soins ou subir les examens appropriés à leur état. Or, dans le cas d'un transport en ambulance bariatrique, l'assurance maladie n'effectue un remboursement que sur la base d'un transport en véhicule sanitaire léger, ce qui ne couvre pas l'intégralité des frais du transport des personnes de forte corpulence, obèses ou en situation de handicap. Ces personnes éprouvent de graves difficultés de mobilité pour se soigner et doivent être transportées dans des conditions particulières. Le transport bariatrique est en effet assuré par plusieurs professionnels pour assurer la qualité et la sécurité du portage du patient et requiert des véhicules adaptés et équipés de matériels spécifiques (brancard élargi supportant de lourdes charges et mus par moteur électrique, chaise à chenille, matériel médical adapté aux personnes obèses). Du fait de l'importance du reste à charge pour le malade, de nombreuses personnes de forte corpulence ou en situation de handicap sont contraintes de renoncer à des soins. Il lui demande de bien vouloir lui indiquer les mesures qu'elle entend prendre en vue de mettre fin à cette discrimination dans l'accès aux soins.

Question· Question écrite21084open

Question 21084 — professions de santé

France · National Assembly · 6 February 2019

M. Jean-Pierre Door appelle l'attention de Mme la ministre des solidarités et de la santé sur la limite d'âge des médecins agréés. Les médecins agréés, généralistes ou spécialistes, sont désignés par l'administration pour siéger aux comités médicaux ou sont chargés par celle-ci ou par les comités médicaux et commissions de réforme d'effectuer des contre-visites et expertises. Ils sont chargés de procéder, pour le compte de l'administration, aux examens médicaux visant l'aptitude physique pour l'admission aux emplois publics, les fonctionnaires lors de leur congé de maladie, de longue durée ou de réintégration à l'issue de tels congés et les contrôles pendant les périodes de maladie. Les médecins agréés pour le permis de conduire, d'autre part, délivrent, après examen et entretien avec les usagers, un avis médical à l'administration sur l'aptitude physique, cognitive et sensorielle à la conduite des véhicules à moteur. Parmi les conditions à remplir pour être agréé en vue de chacune de ces deux fonctions, le médecin doit être âgé de moins de 73 ans. Il demande s'il est envisagé de reculer prochainement la limite d'âge des médecins libéraux souhaitant bénéficier de l'agrément requis pour figurer sur la liste des médecins agréés généralistes et spécialistes établie dans chaque département par le préfet. En raison du nombre restreint de ces médecins et du nombre important d'actes à effectuer, il serait en effet très utile d'élargir les listes départementales en reculant la limite d'âge des médecins agréés. En effet, les médecins en activité, accaparés par leur travail quotidien, ne souhaitent pas souvent exercer une activité supplémentaire. En revanche, nombre de médecins retraités pourraient exercer cette activité. La limite d'âge applicable aux médecins agréés est difficilement explicable dans la mesure où aucune limite d'âge à l'exercice de la médecine n'est imposée. En outre, le nombre de jeunes médecins est devenu insuffisant pour remplacer ceux partis en retraite. Le cumul emploi-retraite est même encouragé pour combler le déficit de médecins dans les zones sous-dotées. Il convient enfin de rappeler que, s'agissant des deux fonctions, la limite d'âge avait déjà été relevée, l'une par décret du 30 mai 2013 et l'autre par arrêté du 31 juillet 2012. Il souhaiterait donc connaître ses intentions sur ce sujet.

Question· Question écrite13892answered

Question 13892 — bois et forêts

France · National Assembly · 10 June 2018

M. Jean-Pierre Door appelle l'attention de M. le ministre de l'agriculture et de l'alimentation sur l'annonce par l'Office national des forêts (ONF), établissement public placé sous sa tutelle, de la fermeture au public, à la fin de l'année 2018, de l'Arboretum national des Barres. L'Arboretum national des Barres, propriété de l'État et géré par l'ONF, comprend 2 600 espèces d'arbres et arbustes issus de cinq continents, et constitue dans la région naturelle de l'est du Gâtinais, un patrimoine végétal remarquable parmi les plus importants d'Europe. Il y a lieu de craindre des conséquences très dommageables de cette fermeture sur le tourisme du département du Loiret et sur l'économie rurale, alors que l'on enregistre 17 000 visiteurs par an. En effet, l'ONF est chargé d'assurer des missions d'accueil et d'éducation, dans le cadre du développement local ainsi que des missions de gestion des collections et de production pour le renouvellement des collections et la promotion des espèces. Soucieux de l'avenir de l'arboretum, il souhaiterait connaître, au-delà de l'ouverture nécessaire de celui-ci au public, les mesures qu'il entend mettre en œuvre en vue d'assurer la pérennité et le rayonnement d'un patrimoine unique, à l'issue du contrat d'objectifs et de performance entre l'État et l'ONF qui prend fin en 2020.

Question· Question écrite12851open

Question 12851 — professions de santé

France · National Assembly · 9 February 2018

M. Jean-Pierre Door attire l'attention de Mme la ministre des solidarités et de la santé sur la situation des praticiens du système de soins (médecins, chirurgiens-dentistes, pharmaciens et sages-femmes) diplômés hors de l'Union européenne (PADHUE). Du fait de l'obtention de leur diplôme hors de l'Union européenne, ces praticiens sont engagés dans des statuts précaires, soumis à des contrats de courte durée, sans perspective d'évolution ni de stabilité dans leur carrière. En outre, leur rémunération, à travail égal, est inférieure à celle de leurs confrères diplômés en France ou dans les autres pays de l'Union européenne. Pour faire valider leurs diplômes et améliorer leur situation, les PADHUE doivent se soumettre à une procédure d'autorisation d'exercice (PAE), analogue à celle qui s'applique aux candidats non-résidents en France. La loi n° 2012-157 du 1er février 2012 relative à l'exercice des professions de médecin, chirurgien-dentiste, pharmacien et sage-femme, pour les professionnels titulaires d'un diplôme obtenu dans un État non membre de l'Union européenne, avait permis une meilleure reconnaissance du parcours professionnel des PADHUE, mais de façon transitoire. Ceux recrutés avant le 3 août 2010 ont continué ainsi à exercer dans les établissements de santé publics et privés d'intérêt collectif jusqu'au 31 décembre 2016. Cette mesure a ensuite été prolongée dans le cadre d'un amendement à la loi Montagne, du 22 décembre 2016, qui recule la date butoir au 31 décembre 2018. Or Mme la ministre s'était engagée devant la représentation parlementaire, en novembre 2017, à modifier la législation actuelle en vue d'intégrer les praticiens diplômés hors de l'Union européenne, en tenant compte de leurs expériences professionnelles acquises en France. En raison de l'évolution inquiétante de la démographie médicale dans le pays, sachant qu'en 2020, 30 % des effectifs de praticiens hospitaliers partiront à la retraite et compte tenu du problème des déserts médicaux contre lequel le plan « Ma santé 2022 », annoncé par le Président de la République, entend lutter, il lui demande quelles mesures elle compte désormais prendre pour améliorer de façon pérenne, à l'instar d'autres pays de l'Union européenne, l'intégration après vérification de leurs connaissances, des praticiens titulaires d'un diplôme obtenu hors de l'Union européenne.

Question· Question écrite12829answered

Question 12829 — presse et livres

France · National Assembly · 9 February 2018

M. Jean-Pierre Door appelle l'attention de Mme la ministre du travail sur le statut des correspondants locaux de presse. L'article 10 de la loi n° 87-39 du 27 janvier 1987, modifié par l'article 16 de la loi n° 93-121 du 27 janvier 1993, précise que « Le correspondant local de la presse régionale ou départementale contribue, selon le déroulement de l'actualité, à la collecte de toute information de proximité relative à une zone déterminée ou à une activité sociale particulière pour le compte d'une entreprise éditrice. Cette contribution consiste en l'apport d'informations soumises avant une éventuelle publication à la vérification ou à la mise en forme préalable par un journaliste professionnel ». Or ces dispositions, qui devaient s'appliquer à des correspondants de presse exerçant à titre accessoire une simple activité de collecte d'informations de proximité, ne correspondent plus actuellement à la réalité de l'activité de nombre d'entre eux. Celle-ci s'apparente, en effet, souvent au travail du journaliste mais, ne fait pas l'objet d'un contrat de travail. La collaboration entre l'entreprise éditrice et le correspondant de presse, qui en pratique ne consiste pas seulement en un travail de collecte mais de rédaction d'un article, est fragile. Celui-ci n'est pas titulaire d'une carte de presse et il est rémunéré par le versement d'honoraires et rattaché au régime de sécurité sociale des non-salariés. Seuls lui sont payés les articles et photographies parus dans le journal. Le correspondant de presse perçoit des honoraires et des remboursements de frais sur la base de barèmes qui diffèrent selon l'entreprise éditrice pour le compte de laquelle il exerce son activité. Alors que l'activité de correspondant local de presse était complémentaire d'une autre activité, celle-ci est de plus en plus exercée dans l'espoir de la signature d'un contrat de travail ou même à titre principal de façon précaire. Il lui demande si elle envisage une adaptation de la législation du point de la relation de travail et de la couverture sociale.

Question· Question écrite3760open

Question 3760 — maladies

France · National Assembly · 11 December 2017

M. Jean-Pierre Door attire l'attention de M. le ministre de l'éducation nationale sur les maladies de la peau et plus précisément sur le cas du mélanome. En effet, dans le cas du mélanome, comme dans tous les cancers, des cellules anormales se multiplient abondamment de façon inhabituelle. Dans le cas du mélanome, ce sont les mélanocytes, cellules responsables de la couleur de peau, qui sont touchés. 10 %, c'est le nombre d'augmentation du nombre de nouveaux cas par an depuis 50 ans. 14 325 nouveaux cas ont été estimés en 2015. 1 773 décès ont été estimés en France dus au mélanome cutané en 2015. Enfin, 80 % des décès liés au mélanome sont parmi les cancers de la peau. Une association « Vaincre le mélanome » a d'ailleurs été créée en juin 2009 par des bénévoles concernés par cette maladie et qui ont souhaité s'investir pour aider les chercheurs et praticiens, et soutenir les patients et leurs proches. Cette association vient récemment de créer un film destiné à la prévention et au dépistage précoce du mélanome. C'est pourquoi il lui demande s'il envisage la diffusion de ce film vidéo dans les collèges afin de pouvoir informer les jeunes sur les risques engendrés par cette maladie.