What about the generalized third-party payment?

Announced as one of the flagship measures of the Health Act 2016 to guarantee everyone access to healthcare, the generalization of the third-party payment was to exempt patients from the payment of the shares of the Compulsory and Complementary (or full third-party payment) on the all of their health expenses.

In a decision of 21 January 2016, the Constitutional Council rejected the generalization of the third-party payment on the part of the Supplementary Regime believing that “the legislator had not sufficiently framed the device and thus disregarded the extent of its own competence”.

The third-party payment device since 1 January 2017
For health professionals For the Supplementary Regime
  • The obligation to practice the third-party payment for patients in ALD or beneficiaries of the Maternity Insurance.
  • The possibility of extending the practice of third-party payment to all patients.
  • The obligation to allow the third-party payment on all services within the scope of responsible contracts.

The point of view of health professionals

The opposition of doctors and dentists to the third-party payment is not new: disempowerment of the patient, commitment to the fee-for-service, complexity of implementation… the arguments put forward are various.

If the practice of the third-party payment is almost systematic for the pharmacy, the laboratory acts are not really developed among the doctors, already late on the care sheet teletransmission with a rate of equipment SESAM-Vitale average of 62 % (50% for specialist doctors in Paris).

 

The evaluation conducted by the General Inspectorate of Social Affairs

The GISA was commissioned by the Ministry of Health to establish an inventory and test the reliability of the RO / RC practices and devices being implemented, and thus determine the most favorable timing for the generalization of the third-party payment.

Although the evaluation of healthcare professionals is generally positive on the third-party payment system of the Compulsory Scheme, it is more critical with the Supplementary Scheme: multitudes of interlocutors, variable amounts of reimbursements, administrative burdens … with a strong requirement: the Compulsory Scheme for compulsory and complementary shares …

In the end, a generalization of the third-party payment in two stages is recommended:

  • First of all, on the part of the Compulsory Scheme for all health professions by 2019, optionally on the complementary part for professions most committed to the third-party payment process (radiologists, health centers, etc.)
  • In a second step without further clarification, to professions most opposed to the practice of the third-party payment , subject to the gradual improvement of the provisions of the Supplementary Regime, the establishment of incentives such as the remuneration of flows.

Consult the report of GISA: http://www.igas.gouv.fr/

The strategic challenge of the Supplementary Scheme: to avoid the positioning of the Compulsory Scheme as a single payer of acts in third-party payment

The Complementary Scheme, meeting within the Inter AMC, as well as the main third-party payment operators grouped within the A3S association, proposed several areas for improvement:

  • Creation of a single platform for PS agreements common to all Supplemental Schemes.
  • Harmonization of rights holders, presence of a Datamatrix code to facilitate identification of the beneficiary.
  • Deployment of the BEI (Beneficiary Entitlement Identification) Standard for real-time interrogation of the beneficiary’s rights with acquisition of a commitment number valid as a guarantee of payment.
  • Improved financial channels for faster settlements and simplified tracking (RO / RC payment reconciliation).

And now ?

The 2018 Social Welfare funding law set on March 31th as the deadline for submitting a report defining the operational implementation schedule for the full third-party payment.
On March 28th, Agnès Buzyn, Minister of Solidarities and Health, confirmed that she wanted to have a schedule for scaling up the additional third-party payment to achieve a “third-party payment which is generalizable, easy, operational and accessible to a l. ”

A postponed but not cancelled generalization?

Presumably … Keeping in mind that the waiver of full cost advance on city care is one of the levers of the necessary rebalancing between city and hospital medicine to save a hospital system on the verge of asphyxiation.

In the meantime, the Complementary Scheme and the technical operators must remain mobilized in order to improve the current processes, propose the implementation of new services and solutions to try to remove the opposition of the liberal doctors.