This is where we touch the heart of the problem

In the recent reform of Medicare, the question of the system of remuneration of doctors was barely touched. It will be necessary to return to. First remember that 20 euros tariff consultation in sector 1, for about three patients at the time, is the remuneration of the generalist below the hourly tariff practiced by the garage. Must admit that it is facing: diagnose his illness and make prescribing the right treatment would seem less paid than to fix his expensive car...

We can understand that some physicians, starting with general practitioners after bac 8, are protest on this subject. Therefore, and to maintain a standard of living in connection with their status, these doctors often reach, and from time to time exceed the 2 time 35 hours a week. It is, particularly, the case in areas where medical density is low, trend which will worsen. Many will say: we did there can nothing and do not run the Act, it is not our fault if our patients call...

This is where we touch the heart of the problem. Some countries have, with many failures and some successes, tried to introduce a dose of medicalized master. Without wanting to dissect what worked or not, which is transposed or less in our country, we can identify actions trying to establish quotas offer only medical often more accounting pretexts and others trying to better control the application, which appears to have been more effective.

An American Organization, Scripp Clinics, held a few years that 10 of potential savings would come better rationalization of the provision of care, 30 of a behavioural change of physicians in their prescription and patterns of interaction with the patient and 60 of a change in behavior of the latter capital health and its application of care. Other impressive statistics from the United States, on the use of the care system: there are only 14 of purely medical needs, 51 of perceived needs and 35 of propensity to consume without actual needs. Should be careful in extrapolating these statistics to the France, but some general practitioners admit that 20 to 30 of their consultations have no real medical reason, and under the control of a medical social application that should be addressed, but not with this type of support.

As it is difficult to check the patient in his application that he believed always legitimate, except to impose a franchise system that can pose real problems of health, acting on the system of remuneration of the doctor that he himself regulates the application of his patient. Transform the largest portion of the revenues to the Act of "capitation", proportional system registered patients and function of the severity of the disease. Maintain a share according to the activity to avoid some perverse effects of this system (for example, do not give a time sufficient for occasional patients). Let the patient regulate the device: if it is not happy with his support, he is free to subscribe elsewhere (if in the alternative), by limiting, to maintain the quality of care, the number of patients per doctor and the proportion of those with long term conditions.

Preserve what is symbolically important for the physician: its direct financial relationship with the patient, who would continue to pay package and would be reimbursed by social security and its complementary mutual. The focus on custom screening, and prevention by encouraging, through the mechanism of capitation, the physician to implement with effective tools such as personal medical record.

What to expect from this revolution "in Chinese" where the doctor would be more encouraged to keep patients healthy wait they are sick to see First, the GP will devote proportionately more time to detect the disease of a patient in the process, to coordinate the care course.

The physician should maintain or slightly increase its revenues by reducing its working hours, which should encourage more vocations. Term, one could imagine a floor of compensation "to the award" the determinants of good health of his patients.

For the paying agencies, the gain will come from requirements avoided on hypochondriac patients, the acceleration of diagnostics, prevention more focused of the patient, with more time on serious cases, representing the vast majority of the costs. In the context of the current reform, the decline of medical demography, the legitimate complaints of the medical corps before the erosion of their standard of living and their increasing workload, our health care system deserves that we implement gradually the device, which appears triple winner for patients, doctors and health insurance.