Health stakeholders feel cheated by the Social Security budget

The CSMF liberal doctors’ union has announced its withdrawal from the conventional negotiations which have just started, for lack of ground to grind for upgrades. Hospitals regret that multi-year spending commitments have been dissolved in budgets to fight Covid and increase salaries.

Liberal doctors are unhappy because the Social Security budget provides only 300 million euros to revalue city care in 2021.

Enough is enough. Jean-Paul Ortiz, the president of the CSMF, one of the main unions of liberal doctors, announced on Wednesday that he was giving up participating in the conventional negotiations which have just opened with Medicare. Reason: “Lack of consideration”, he explains.

Liberal health professionals discovered with amazement that the Social Security draft budget for 2021, presented to the Council of Ministers on Wednesday, provided for 300 million euros for the increase in their overall remuneration for next year. There will be too little grain to grind for conventional negotiators, they accuse.

“Yet we were applauded, too, every evening at 8 pm”, proclaims Jean-Paul Ortiz, recalling that the Liberals patiently waited their turn, in June-July, during the negotiation of the “Ségur de la santé”, designed to reinvest in hospital salaries and infrastructure. The trade unionist also underlines that doctors lost 1.5 billion euros in activity income in 2020 due to the under-consumption of care during the crisis. “I deduced that there would be at least 2 billion euros more for city care, including 1 billion for doctors”, he explains.

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The CSMF is not the only union to be moved. In a press release published on Friday, MG France (general practitioners) brocade an envelope which corresponds to an increase of 50 cents in the price of the act. “It is impossible to wait almost three years without upgrades. We will look for these means, asking for more money and without delay ”, warns the president of the union, Jacques Battistoni, who is not leaving the negotiating table at this stage. The unions want the upgrades to take place in January, by way of derogation from the usual six-month period between the signing of an amendment and its implementation.

Multi-year commitments

There is a real paradox in seeing the Social Security budget project for 2021, one of the most expensive in history, as the Court of Auditors points out, being criticized by health actors for its lack of generosity. In 2021, the government has forecast $ 9 billion in additional net health insurance spending compared to the corrected 2020 target – and $ 19 billion more than the initial target! But this profusion is mainly due to exceptional measures to fight against the coronavirus – the purchase of masks, tests, etc. – and to the salary increases which are certainly exceptional, but lasting, of the “Ségur de la santé”.

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Suddenly, even hospitals consider that they have been cheated. “If we remove the funding obtained during the Segur and the additional costs linked to the Covid, we end up with a health insurance expenditure target lower than what was planned and protected by the multi-annuality. How can we ask so much of health actors without giving them the means to achieve their objectives? “ scolds Frédéric Valletoux, the president of the Hospital Federation of France (FHF).

In 2019, the government guaranteed health establishments a minimum increase of 2.4% of their resources each year until 2022, corresponding to 2 billion euros for 2021. “Far from the level expected and necessary to face irreducible additional costs, the figures brought to our attention – an envelope of 1.3 billion euros – do not seem to correspond to the initial commitments”, regrets the FHF, which is asking for 500 million more for 2020 and 700 million for 2021 for hospitals, as well as credits to start creating 20,000 jobs in the elderly sector.