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The “bazaar” of the remuneration of liberal doctors, issue of the conventional battle


How much will a consultation with a GP cost tomorrow? How – on a fee-for-service basis – will liberal doctors be remunerated, and how high? These questions are at the heart of the contractual negotiations carried out with the Health Insurance to redefine, for the next five years, their conditions of exercise and remuneration.

Negotiations are tough. The unions – the Confederation of French Medical Unions (CSMF), MG France, Avenir Spé, the French Union for Free Medicine (UFML), the Federation of Doctors of France (FMF) and the Union of Liberal Doctors (SML) – suspended their participation in mid-January. At issue, in particular, is a “territorial commitment contract” to which several levels of consultation would be linked, welcomed as a call for ” Work more to earn more “.

These same unions have returned sit down, wednesday 1er and Thursday, February 2, at the conventional table for a new session of bilateral meetings. But the atmosphere remains tense. They were expecting a ” opening “ from Medicare: the detail, in figures, of the levels of the revaluation envisaged. Barely out, they expressed their deep disappointment : Medicare proposes, at this stage, to revalue the reference consultation by 1.50 euro (excluding territorial commitment contract, still under discussion), which would bring the “basic” price to 26.50 euros, against 25 euros today. Far from union expectations.

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What would be their “just” reward? This question no longer resounds only among the interested parties – 113,000 independent doctors, including 57,000 general practitioners. The posting of the requirements of a part of the profession – the claim of a “consultation at 50 euros”put forward by a fringe of doctors and transformed into a slogan – questions within patient associations in particular.

Acts and packages

The discussions, in reality, are more complex than this slogan and find an echo on the political scene, where access to care and the fight against medical deserts have been made a priority. The remuneration of the doctors is not made up only of the payment of the consultation. If fee-for-service, with free fees, was the only form of payment when the Charter of Liberal Medicine defined its practice at the end of the 1920s, things have changed a lot since then, at the pace of “conventions medical services”, with the fixing of conventional tariffs and the introduction of additional payments, essentially in the form of lump sums.

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