The director of Medicare does not hide its intention, revealing new figures on excess fees, weigh on the negotiations with private doctors, which should lead to early summer. "The system just drift since its inception 30 years ago, Frederick van Roekeghem regrets. We want to sound the alarm on the need to implement structural reforms. "
Overruns (these are requested beyond the "tariff Safely" legally by doctors of "Sector 2 but poorly repaid by certain complementary health) accounted last year for 2.5 billion euros, on a total of 20.9 billion euros in fees. A proportion is similar in style singled out by the Inspectorate of Social Affairs in 2004, which argued that while a "significant increase" during the previous decade.But behind this "apparent stability", says Fred van Roekeghem lies a greater concentration.
In 1990, 16% of physicians "family" could charge excess fees. Since then, the degree requirements were introduced which prevent virtually any plant of the generalist sector 2, and only 7% of workforce is concerned. The proportion of specialists in Area 2, with her stable for the past twenty years (41% in 2010). But if she fell for clinical specialties (pediatricians, dermatologists, gastroenterologists between 32% and 40%), it flies in the operating room: 34% against 28% for anesthesiologists, 85% against 73% for surgeons.And in all these areas, the sector will expand in the next two years as junior doctors settle overwhelmingly.
Physicians increasingly "greedy"
In addition, doctors applying overruns are becoming more "gourmet" on the amounts required: 54% of the "Safely rate, on average, against 25% in 1990. Note that Medicare confirms the intuition of the French Mutuality: 4.5% of public hospital doctors allowed to perform – for 20% of their working time to the maximum – a professional activity in area 2 practice overruns higher than their liberal counterparts "pure." Supplements such resources reach 81% in surgery, against 56% in the private sector, 80% against 48% in ENT, ophthalmology, or 96%, 60% cons.
Overtaking both more frequent and higher are concentrated in certain areas – with high purchasing power – like Paris and West of the Ile-de-France, Rhône, Alsace and the Coast d'Azur.
A problem of access to care
Nevertheless. "The phenomenon empire, says Frederick van Roekeghem. It poses a problem of access to care. " The boss of Medicare does not refute the argument of doctors (surgeons in particular): they are using the overruns is that the social security system pays too little certain acts, given their cost, their difficulty, duration, or the risk that affects the amount of insurance premiums. It's good to help doctors make more money without costing too much to Medicare that the sector 2 was created in 1980 by Raymond Barre.And it's not a coincidence that the least among specialists in Sector 2 are installed cardiologists (20%) and radiologists (13%), considered very good living by simply make rates Safely.
Frederick van Roekeghem says ready to act on the question to finally allow the entry into force of the solution advocated since 2004: the "optional sector. This would be for anesthesiologists, surgeons and obstetricians Area 2 volunteers to achieve at least 30% of their actions and costs Safely, do not charge for overruns over 50% on the rest of their activity, complementary health s 'committing their part to repay the money. "This discussion will reopen. I think it's the last time, "warns the director of Medicare.
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