The president, who presents his first wishes to caregivers this Friday, has implemented several key provisions of his 2017 program. But the sale of drugs by unit, which could have facilitated the very delicate supply of antibiotics in recent weeks , or generalizable third-party payment have not taken place.
Much awaited by the hospital world in great suffering for several years, Emmanuel Macron wishes them this Friday. Olivier Véran, the government spokesman, promised on BFMTV “a landmark speech” while the Elysée should make “very concrete” announcements.
The executive has multiplied promises since 2017, with varying success. The Ségur de la santé, criticized by caregivers while having allowed salary increases, was not part of his campaign proposals but directly linked to the impact of the Covid crisis.
The end of the numerus clausus
Promise of 2017, Emmanuel Macron wanted, during his first five-year term, to end the “mess” of the numerus clausus which capped the number of students entering the second year of medicine and therefore doctors at the end of their studies. This device was regularly seen as one of the explanations for medical deserts.
Since September 2021, the number of places in the second year of medicine is now determined by the universities, according to the “health needs of the territory”. But with rather long studies, the results of this reform will not be seen for several years concretely on the ground.
The doubling of nursing homes
To cope with the scarcity of doctors in the territory, the president had announced that he wanted to double the number of health centers which makes it possible to bring together general practitioners and specialists in the same place, sometimes with paramedics such as nurses or physiotherapists.
While there were 1118 in France in 2017, they were 2020 in 2022.
The zero remains payable for glasses and prostheses
Then candidate, Emmanuel Macron had promised that his five-year term would be marked by 100% coverage of certain glasses, dentures and hearing aids by social security and complementary health.
The reform voted in 2018 was done gradually. From January 1, 2019, policyholders were able to benefit from baskets of offers which were better and better reimbursed until full reimbursement at the start of 2021. However, with one downside: a majority of opticians and hearing aid professionals do not apply reform.
Sale of drugs individually
The generalization of the sale of drugs by unit had been set as an objective during the first five-year term of the president. Under the impetus of Marisol Touraine, then Minister of Health, the measure had already been the subject of an experiment on antibiotics during the presidency of François Hollande.
The measure was finally voted on in December 2019, with the objective of coming into force no later than January 1, 2022. A year later, if the implementing texts have been voted on, they are clearly still not applied, particularly in the face of resistance from laboratories.
In full tension in recent weeks on the supply of some of the most prescribed antibiotics in France, such as amoxicillin, the Ministry of Health has recommended that pharmacies issue one unit – without much success so far.
Generalizable third-party payment
Thorny subject for doctors, Emmanuel Macron had proposed to deploy third-party payment – this device which allows not to advance costs to health professionals – in a “generalizable, simple and effective” way, “without constraint” for general practitioners .
But a few months after the 2017 presidential campaign, the General Inspectorate of Social Affairs considers the measure “unrealistic” and evokes “technical brakes” on the part of mutuals. While it should finally be operational at the end of 2019 under the impetus of Agnès Buzyn, then Minister of Health, the system was not deployed and completely stopped with the Covid-19 crisis.
While general practitioners are now calling for the price of the consultation to be increased from 25 euros to 50 euros, the generalizable third-party payment should not succeed.
