The approximately 1,500 medical advisors of the Health Insurance, who play a key role in the fight against fraud and in the granting of benefits and reimbursements, are at the heart of a reform project that is raising fears for their independence and worrying the unions.
The management of the Health Insurance wishes that this medical service, long endowed with a certain functional independence, be incorporated into the general organization of the Health Insurance.
According to his plan, presented Thursday to the central social and economic committee of the CNAM, the 16 regional directorates of the medical service would disappear and the 7,200 people who make it up – practitioners and agents – would be distributed among the hundred or so primary health insurance funds (departmental).
"Tomorrow, the body that monitors sick leave (among other things) will be absorbed by the primary health insurance funds: there is reason to fear that the management of the opinions issued will be more accountable and algorithmic than medical," laments a CGT/FO/CFE-CGC inter-union.
At a time when a new tightening of health spending is likely, unions fear that medical advisors, now attached to primary health insurance funds, will lose their independence and end up being influenced by fund management regarding the granting of long-term illness status, the granting or extension of sick leave, disability benefits, or incapacity pensions. These are crucial decisions for users.
They also fear the consequences for non-medical staff who will have to be spread across the entire network of primary health insurance funds.
"The sudden announcement of this very short-term elimination, starting on April 1, 2025, is shocking and causing great anxiety among employees," the inter-union organization stressed.
Administrative agents who work with practitioners and share medical confidentiality with them fear losing the specificity of their missions "listening to the patient," explains Cedric Bertet-Pilon, an elected CGT agent of the regional management of the Auvergne Rhone-Alpes medical service.
"We know that any patient we see has cancer or multiple sclerosis, and we share medical confidentiality. This is what patients risk losing," added Mr. Bertet-Pilon.
– Liberal doctors are wondering –
The union of independent doctors CSMF also expressed its concern.
The health insurance medical service must give its opinions "in complete independence and with respect for medical confidentiality," he stressed in a press release on Thursday.
"At a time when the Cnam is considering an awareness policy regarding sick leave, medical transport prescriptions or dual-zone prescriptions (for patients with long-term illnesses), seeing the medical service disappear in the very short term raises questions," he said, asking the Cnam to "clarify its position."
The Cnam management told AFP that the independence of medical advisors "would be guaranteed on a daily basis thanks to a dual evaluation system" for practitioners.
The medical aspect of her activity will not be assessed by the director of her affiliated fund but by another "professional medical advisor," she said.
And "to take into account the specificities of medical practice, the national collective agreement for consultant practitioners under the general social security scheme is fully maintained, as is the national management of this body (in terms of recruitment and mobility)," she added.
"This logic, which brings medical and administrative teams together, already exists in many organizations (agricultural social security funds, ARS, health agencies)," she added.
The call for a strike launched on the day of the presentation to the social and economic committee was widely followed within the medical service, according to Cedric Bertet-Pilon, who mentioned participation rates "of 40 to 100" depending on the region.
The CNAM's central social and economic committee will be asked to provide an opinion on the reform project within a few months. In the meantime, elected officials have requested that an expert review of the project be conducted, Mr. Bertet-Pilon said.
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