government tries to rein in spending, doctors challenge method

Are there more and more sick leaves prescribed? Many doctors answer in the affirmative. But are there “too many”? The question seems ill-posed to them., even if it refers to the quantified observation advanced, still recently, by Health Insurance: expenditure on daily allowances, excluding Covid-19, jumped by 8.2% in 2022 to reach 13.5 billion euros (excluding maternity); an increase “above the dynamics” pre-pandemic, warned the body in its report “Expenses and income” released at the end of June and which, like every year, sets some of the trends that will be found in the financing bill of Social Security, debated in the National Assembly in the fall.

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This year, there is little suspense: cutting health spending, in particular by fighting against the increase in sick leave, is one of the savings levers identified to straighten out public accounts. A lever – among others – which, according to the authorities, would reduce the health insurance deficit by 250 million euros in 2024.

Except that the equation does not convince the liberal doctors, asked to fight, on their scale, against the “overprescription” sick leave: “To settle for a table with figures is to miss the real issue”argues Agnès Giannotti, president of MG France, the first union of general practitioners, recalling that three years of health crisis, followed by a revival of professional activity have had a strong impact on the health of the French. “By asking colleagues who are supposed to be ‘too much’ prescribers to do ‘less’, we want to break the thermometershe says, but that won’t make the evil go away. If the statistics are racing, there are reasons! »

“I don’t have a magic wand”

A speech that resonates strongly on the ground. “The authorities invoke figures, expenses, the budget, while we talk about patients, suffering, care… We are bordering on the dialogue of the deaf”underlines Doctor D., recently installed in the Lyon metropolis – he requested anonymity, like all the doctors who agreed to testify.

This young general practitioner has recently been affected by a so-called “targeting” procedure: his primary fund contacted him in June to notify him of a target to reduce his sick leave prescriptions, the number of which has was judged to be superior to that of physicians practicing under comparable conditions. A ” patch ” to materialize over six months – between September 2023 and February 2024 –, except to expose oneself to a fine. A ” cold shower “he said.

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