Pay for hospital emergency departments to redirect patients presenting with the pathology of the less severe to the medicine of city… This is the astonishing proposal made by Olivier Véran, mp (LRM) of the Isère and general rapporteur of the committee on social affairs, within the framework of an amendment to the draft law of financing social security. The measure, which was adopted in committee Wednesday 17 October, aims to reduce congestion in the emergency services, including the attendance increases of 2 % to 3 % each year for fifteen years, now reaching 23 million of annual passages.

However, more than a quarter of these passages ” could have been taken in charge by a general practitioner on the same day or the next day, without the need of additional examinations “, said Mr. Veran. In order to induce the hospital to give up a source of income (each passage with emergencies relating to average 161,50€, according to the Court of auditors in 2014), the mp proposes to create a “package of reorientation” of 20 to 60 euros.

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“Against the tendency to make the numbers”

the hospital would receive for each patient came to the emergency room who would have been offered an appointment in a short period of time in a doctor from town, in a house, medical care or a consultation with a hospital specialist. With such an arrangement, the elected judge possible to be able to redirect up to ” 6 million patients every year “, the latter being free to accept or reject this shift.

The measure received a first home in the half shade of the part of health professionals. There are concerns about the practical modalities of its implementation. “Who will refer patients ? If it is the physician, this is of no interest. It must be the nurse welcome and orientation, to which it will have very specific rules, as it will have a responsibility not negligible “, underlines François Braun, the president of UAS-Er of France, while expressing the view that it is a “good idea” because it will ” fight against the tendency to want to make the numbers “.

A position opposite that of the Association of emergency physicians of France (AMUF). Christophe Prudhomme, spokesman for the AMUF, considers the proposal “unrealistic” and calls of ” kick the media “. “The medicine of city is affected,” he said. General practitioners can’t do more than what they are today. It is illusory to imagine that we are going to relieve the came to the emergency department with measures of this type. “

The trade unions of the liberal doctors have, for their part, expressed their astonishment, not to obtain financial assistance to support such consultations have not been scheduled. “Give 60 euros to the hospital to send a patient to see a doctor town at 25 euros the consultation, you find that logical ? “asks Jean-Paul Ortiz, president of the Confédération des syndicats médicaux français, the first union of liberal physicians, which advocates for the implementation of a package for the patients taken into emergency by the physicians of the city.

“Under-utilisation of general medicine”

In fact, the doctors on duty are already 60 euros for the consultation carried out between 20 hours and midnight, 65 euros for those performed between midnight and 6 o’clock in the morning and 44,06 € for the Sunday. The consultation “standard” of the day at 25 euros is not, however, be increased if it is taken in an emergency. “It is not necessary to take the liberal physicians for persons subject to tallage and exploitable to thank you,” warns Jean-Paul Hamon, president of the Federation of doctors of France, while judging the approach of Olivier Véran ” interesting “.

even Before the passing of such a measure, which the member of parliament for the Isère ensures that it has the support of the minister of health, Agnes Buzyn, experiments with similar objectives have already been launched. Since the 1st of September, in Annemasse (Haute-Savoie), a liberal doctor splitter, placed behind the nurse at the reception in the emergency department, available every evening, between 18 hours and 22 hours, for patients without life-threatening emergency access to an appointment within a period of thirty to forty minutes in a doctor’s liberal guard, located at a maximum distance of 20 km. The possibility for these patients to avoid three to four hours of waiting in the er…

“there are between ten and twenty consultations per hour, which could be avoided in the er during this time, as there is in the same time an under-use of the liberal medicine,” explains David Macheda, physician, and treasurer of the regional Union of health professionals, who led the project. “The hospital agrees to lose a part of his package, but that leaves more time for the caregiver to true emergencies “, he adds. The objective of the experimentation : being able to ” redistribute ten consultations per evening “, before a possible expansion of the device during the day in the summer of 2019.


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