Since 1 January 2006, all French people should seek medical advice before going through a physician designated to be repaid by Social Security. Some exceptions exist. Overview.
To encourage the French to limit repeat visits to specialists, since 1 January 2006, each insured person over the age of 16 must have chosen a doctor. This is most often a GP but can also be a specialist. Before consulting a specialist, fitness trail provides a pass in the first place in the designated doctor's office. This according to the diagnosis that he poses can refer the patient to a specialist or not. If the term health is met, the refund of Social Security is at the full rate (70%). Conversely, if the fitness trail is not respected and that the patient is referred directly to a specialist without going through his doctor said, the reimbursement is less than 60%.
The track in practice
The course aims to improve health care as it promotes better coordination between different stakeholders in health. The designated physician thus acts as a pivot between the different specialists. It considers whether the interest of the patient to see a specialist for a given disease. Exceptions to the fitness trail, however, allowed for direct access to specialists while maintaining a repayment rate of 70% full. This is so for dentists, gynecologists (including the prescription of periodic screening, such as smears, mammograms), ophthalmologists (safety glasses).
For young people between 16 and 25 years, direct access to a psychiatrist is also planned outside the fitness trail. When consulting a specialist is necessitated by an emergency or a removal from home (during vacation or travel for example), the passage by the attending physician is not required. In case of chronic illness (cancer, diabetes, severe hypertension, Parkinson's, arthritis, etc..) Requiring regular care of a specialist, the passage by the attending physician is also superfluous. The patient can consult the specialists who follow direct access from the moment they are enrolled in the protocol for patient care.
Substantial savings
The term managed care by the attending physician was introduced by the reform of health insurance in August 2004. Its objective is to improve the medical care of patients through better care coordination. Today the term managed care by the attending physician is permanently installed in the customs of patients and health professionals. According to the health insurance, 80% of the insured (40 million people) reported that their physician and 99.5% chose a general practitioner. These have met expectations for their patients, since 98% of GPs are doctors. Financially, the term managed care helps control health care costs. In fact, according to Health Insurance, the establishment of coordinated treatment pathway resulted in a reduced use of clinical specialties (not direct access) whose activity has decreased by 4% by volume. Medical control efforts have achieved 1.3 billion euros saved in two years.
