The letter input by the Halde COMEG CoMeGAS
Collectif des Médecins Généralistes pour l’Accès aux Soins
Le 1er août 2008
Monsieur Louis SCHWEITZER
Président de la HALDE
11 rue Saint Georges
75009 PARIS
Mr. President,
By a letter dated June 27, 2006, I had the honor to refer to the High Authority on behalf of the Collective of GP for Access to Care (COMEG) the discriminatory nature refusal of patient care CMU beneficiaries, highlighted by the report of the fund CMU published June 21, 2006. Subsequently, the ISSC and Dr. Georges Yoram Federmann had done to you that same approach. In your deliberation
2006-232 of 6 November 2006, the High Authority had confirmed and clarified the nature of these discriminatory practices. To prevent recurrence of such facts, you had recommended to social security agencies, among others, to take the necessary steps to inform users and health professionals, prevention and punishment of such practices. I will not repeat the action which had been driven media and political deliberation and the seizure of the HALDE. Reports, taken from various positions and polemics, commissions and statements of intent, etc.. Had followed.
During this case, some health professionals, some union officials or ordinals, had stressed that they had be abnormal behavior, unruly and abusive recipients of CMU to explain or justify the unlawful conduct, ethics and anti-discriminatory some of their colleagues; behaviors that contribute to worsening social inequalities in health in our country. These doctors put forward that the beneficiaries of the CMU does not comply with the scheduled appointments, have special requirements, inappropriate behavior, etc.. Some generalizing from rare and exceptional situations, went so far as to doubt the reality of the material situation patients receiving the CMU. These attitudes, according to them, disrupting the smooth functioning of their health care facilities, or would not guarantee compliance with the conditions they deem necessary for the proper care relationship. Unfortunately
never any evidence or study have made it possible to establish these allegations. Nothing in particular no evidence that these behaviors are more frequent among recipients of CMU and the rest of the population. In addition, for those most desocialised, so part of CMU beneficiaries, constraints appointments too stringent or formalities of access to care too complex may constitute barriers to access to care. In the absence of any evidence showing a greater frequency of abusive behaviors known among recipients of CMU, these claims remain unsubstantiated, and seem to be based on preconceptions and generalizations. Their discriminatory nature seems clear.
Health professionals on the ground alongside the most vulnerable patients, physicians COMEG know that these words are often taken as an attempt to prove to the hypocritical refusal of care related in socio-economic and cultural patients. Members of COMEG even know that some professionals, fortunately uncommon, aware of the obstacles to accessing care that are for the most disadvantaged tape, set up complex procedures and discrimination may discourage these people:
- beaches Hourly taken specific appointment telephone
- beaches consultations "reserved" for patients with the CMU,
- obligation to take an appointment by or with the third letter of introduction from another doctor,
- they must present the card vital to take advantage of third-party payment
- etc.
But the Medicare, in his "Letter to doctors 'No. 29 of June 2008, and in Circular 33/2008, signed by its Director General, under which' management of claims and complaints recipients of CMU or complementary health professionals, "formalizes and takes over the allegations of some doctors, giving them the possibility of bringing claims and complaints to the Health Insurance conciliator cons patients receiving the supplementary CMU. Behavior "Abusive" are appealable even listed:
- undue delays to appointments
- missed appointments and not canceled
- consecutive or non-treatment
- exorbitant demands ... The
COMEG grabs your attention and that of the HALDE the fact that the procedures of complaints and claims do not relate to other social insurance, not subject to the CMU, and who surrendered "guilty" of these behaviors. They could therefore be pursued with impunity. COMEG believes that the discriminatory ability for doctors to complain against patients receiving specific the CMU complementary to the objections mentioned in these documents or otherwise. The
COMEG grabs your attention and that of the High Authority on the infringement of individual liberties is the third grievance as abusive and entitled: "Treatment not completed or interrupted." The CMU beneficiaries would no longer have the right, unlike other citizens, to decide not to undergo treatment or discontinued for reasons of their own, without the risk of being reported to Insurance. This measure is opposed to the spirit and letter of the law 2002-203 of 4 mars 2002 relative aux droits des malades et à la qualité du système de soins, et en particulier à l’article L.1111-4 du Code de la santé publique, créé par cette loi, qui concerne le respect de la liberté de choix des patients par les médecins.
Le CoMeGAS attire votre attention et celle de la HALDE sur le caractère arbitraire du quatrième grief intitulé « exigences exorbitantes… ». Sur quels critères en effet le professionnel de santé déciderait-il du caractère exorbitant de telle exigence ? L’exorbitance d’une exigence ne risque-t-elle pas d’être parfois inversement proportionnelle à la capacité du patient à la payer, thus fostering care practices at multiple speeds and reducing in-patient treatment of CMU to a "minimum service" guaranteed by law, beyond which any application would potentially "outrageous"? The
COMEG fears that the introduction of these reporting practices creates, often troubled citizen vis-à-vis the government, new stigma with health insurance services. These stigmas (patients labeled "problem", "difficult", "non-observant," etc..) Increase feelings of discomfort, shame and misunderstanding of those insured in their dealings with health insurance. These feelings are often strained relations generators, even violent, and only aggravate the situations of exclusion. The
COMEG believes that the introduction of these measures for reporting back to put under conditions of 'good behavior' access to care for those beneficiaries of the CMU, recalling that the ladies of the 19th century work demanded "their" poor to exercise their charity. Conditions that are not required of other insured persons and highlight the discriminatory nature of these measures.
The
COMEG finally draws your attention and that of the High Authority on the absurdity of this measure, which is to introduce discriminatory measures, even illegal, to end the discrimination that constitute the refusal of care.
The total COMEG believes that these measures represent a violation of Article L.1110-3 of the Code of Public Health, established by the Act of March 4, 2002, which states that "no person may be the subject to discrimination in access to prevention or care. "Accordingly, the COMEG application to the High Authority against Discrimination and for Equality that is recognized the discriminatory and unequal to the circular 33-2008 and the "Letter to Physicians' Health Insurance, Access to Care for a portion of the population among the most vulnerable to health problems. We ask that HALDE intervene with health insurance so that these provisions be rescinded. The
COMEG also highlighted the appalling nature of a situation that leads health insurance secured to allow caregivers to make a complaint against its insured, to try to fix what does that relationship difficulties, among others related to a prior to the most vulnerable members of our society. This confirms the finding of COMEG the inadequate training of health professionals, and physicians in particular, to the knowledge of the realities of life for those most vulnerable and sickest of our society and their care, whereas because of their health care mission, they should be "experts". The judge COMEG priority that training in the care of people insecure is registered in university programs for future physicians, and the themes of conventional medical doctors training funded by the National Health Insurance
Regretting duty, again, enter the HALDE on this fundamental issue of access to care for the poorest, and not doubting the favorable attention that you will grant our request, we ask you to accept, Mr. President the expression of our highest consideration.
For COMEG, Dr Philip
Foucras
