IAre the relations between city medicine and the State inherently conflicting? In recent months, liberal doctors have risen to the top of the bill in their conflict with the state, to hold the picket line. The result did not satisfy anyone: the consultation fees that their unions demanded remained a dead letter. The principle of a “territorial commitment contract”, which the Health Insurance defended, linking higher remuneration to “counterparties”, was challenged, after unanimously against him.
The stormy sequence ends in a quasi-status quo: the “arbitration rules”, formalized on April 24, two months after the failure of the medical convention, is only intended to temporarily administer the conditions for the exercise of the profession. Before new negotiations.
What feed the feeling of powerlessness to move the lines, while the situation of medical deserts worsens. Beyond the medical shortage, the functioning of the city health system is, it is true, difficult to change because of its mixed nature: if health expenditure is “socialized” – in other words, public – to the benefit of the patient reimbursed by Social Security, the city doctor is not, however, a civil servant paid by the State. He remains a liberal, master of his activity, although it is supervised.
” Rights and duties “
This ambiguity, the Head of State underlined it by meeting caregivers during a visit to the Vendôme health center (Loir-et-Cher), on April 25. “There is no real medical liberalism”, argued Emmanuel Macron, recalling the importance of “solidarity” at the heart of the French model, facing doctors, midwives and physiotherapists practicing a collective exercise. This solidarity is a “very good thing”he also maintained, but that supposes “mechanisms of individual responsibility”.
This call to order does not surprise those who know the complex history of the relationship between doctors and the State. “It was forged in the conflict”, explains economist Nicolas Da Silva. From the charter of liberal medicine in 1927 to the first national convention in 1971, including the advent of social security in 1945, doctors fought to maintain a liberal organization by opposing third party interference between them and their patients. “It’s a guiding thread in the profession”, summarizes the teacher-researcher at the Sorbonne-Paris-Nord University. Even though the “Safety” massively solve the income of the liberals (through the agreement with the Health Insurance), since the 1970s.
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