Mr A Sebaoun
Cardiology care in France is delivered both in hospitals and private practice. 3800 private practice cardiologists handle 80% of all cardiologists’ appointments and call for 50% of hospitalisations, while 2400 cardiologists, of whom half are academics, work in hospitals. The Health Minister sets the cost of each medical act and patients have 70 to 100% of their expenses reimbursed depending on the seriousness of their condition.
Cardiology care in France is important and the State finds that its health care costs are unbearable.
In private practice, cardiologists are free to choose where they live and set up their practice. They pay their employees and buy their own equipment. When they set up their practice, they must declare their activity to all relevant authorities and to the Social Security. They then sign the negociated convention with the doctors’ unions (negociated in theory, however the government now makes decisions on its own because no agreement has come out of negociations with cardiologsts and specialists).
The cardiologist must then develop a network of colleagues who know him so that he will have patients referred to him. Nevertheless, a patient can see a specialist directly without any penalty and wherever the patient may be. For example a cardiologist who practices in Marseille may consult a patient from Paris without any problem.
Each medical act is reimbursed by the Social Security either on the basis of a form supplied and completed by the doctor and given to the patient, or directly through an electronic form transferred by the doctor to Social Security using the “Sesam Vitale” card – a personal card with a memory chip received by the patient from Social Security. With this last method, all reimbursements are done through bank transfers, making the process entirely electronic.
For example, a doctor’s appointment lasting a half hour (an average length) is paid 45€ , a cardiac echography, 100€ , a Holter ECG or a stress test, 80€.
When a cardiologist works in a private clinic (for hospitalised patients) his fees are paid directly to him by Social Security. In addition the clinic receives a set per diem fee.
In public hospitals, doctors are salaried workers even though a number of them are permitted one or two private consultations per week. Social Security will reimburse hospital fees on a set per diem basic rate, much higher than in private clinics because it includes all fees, medicine, laboratory and surgical costs.
Hospitalisation accounts for 50% of health costs, doctor fees, 10 to 15%, and medicine, another 10 to 15%.
We are actually experimenting new ways to organise treatment care, through health networks, especially for chronic and expensive diseases such as heart failure, diabetes and AIDS. Cardiologists themselves would also like to experiment with using medical technicians (which exist in the United States) to compensate for the lack of doctors already being felt, but not acutely, in our country, that is, unless immigration compensates for it.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
Vol4 N°06 Supp
Our mission: To reduce the burden of cardiovascular disease
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