Will they sign? Will not sign? After two marathon days of discussions at the Health Insurance headquarters in Paris, the six unions representing private doctors left the building at Porte de Montreuil on Friday, May 17 in the evening, with the feeling of having been generally heard. But, after six months of often stormy conventional negotiations, they have for the moment been careful not to commit to their future signature.
And for good reason: they do not yet have the final draft of the medical agreement, this contract which must fix, for five years, the conditions of exercise and remuneration of the entire profession. “A few elements still need to be clarified, we will send the final text at the very beginning of the week”, probably from Monday, promised, Friday evening, the director general of Health Insurance, Thomas Fatôme. Each union will then consult its base, before expressing its official position. Health Insurance hopes to close the conventional series around May 27.
Among the unresolved elements, one, a little technical, is anything but a detail, since it opposes generalists and specialists: will a specialist be able, tomorrow, to rate a “one-off consultant opinion” (an “APC ”, in medical jargon), at the request of another specialist, without going through the attending physician? In other words, will a pulmonologist be able to refer his patient to a cardiologist, for example, without asking him to first go back to his general practitioner?
A “red line”
The question is important, not only because the value of this act, if the new agreement is signed, will increase, in December, from 56.50 euros to 60 euros: the MG France union, the majority among general practitioners, has conditioned its signature to the withdrawal of this path of evolution. “The role of the attending physician, the consistency of the care pathway must be respecteddefends Agnès Giannotti, its president. It is not possible, in one sentence, to erase them in this way. This is our red line. » Same positioning of the CSMF, or the UFML, which makes it a “blocking factor”, while Avenir Spé-Le Bloc, the majority union among specialists, seems to support the option. The signatures of MG and Avenir Spé-Le Bloc, in the majority for their college, would be enough to validate the agreement.
Beyond this sticking point, a form of agreement was found on the timetable for tariff increases. By finally announcing the most emblematic price increases for December – such as the 30 euro consultation with a general practitioner (compared to 26.50 euros today), or the APC, therefore, at 60 euros – Health Insurance seems having scored points. The day before, on the contrary, she had aroused annoyance by proposing either to distribute these revaluations in two stages between 2024 and 2025, or by considering them all together, but in 2025.
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