Système de santé

Responsabiliser financièrement le patient n’a aucun sens

Ticket modĂ©rateur ou ticket d’exclusion ?
lundi 5 février 2007

Des mêmes auteurs

 
JPEG - 7 ko
Elie Arié

Elie AriĂ© est cardiologue, enseignant associĂ© Ă  la chaire d’Ă©conomie et gestion des services de santĂ© au Conservatoire national des arts et mĂ©tiers. Il est proche de Jean-Pierre Chevènement et a Ă©tĂ©, au MRC, dĂ©lĂ©guĂ© national Ă  la santĂ© [1].

Dans un entretien rĂ©cent [2], Nicolas Sarkozy, abordant le thème des dĂ©penses de santĂ©, rĂ©pète Ă  deux reprises : " Il faut essentiellement responsabiliser le patient. " par des franchises de remboursement (ticket modĂ©rateur - qui existe dĂ©jĂ  et qui est un des plus Ă©levĂ©s d’Europe).

Responsabiliser financièrement le patient n’a Ă©conomiquement aucun sens dans la consommation mĂ©dicale qui est, pour l’essentiel, une Ă©conomie subie et non choisie ; on ne choisit pas d’ĂŞtre malade et, quand on l’est, on n’est pas compĂ©tent pour juger des dĂ©penses qui vous sont prescrites. Si votre mĂ©decin vous prescrit un scanner, sur quelles bases pouvez-vous juger qu’il n’est pas indispensable ?
En revanche, l’importance de la franchise peut dissuader financièrement les plus faibles revenus de se soigner : le ticket modĂ©rateur est en rĂ©alitĂ© un ticket d’exclusion, puisqu’il ne joue que sur les possibilitĂ©s financières de chacun, sans prendre en compte aucun critère d’utilitĂ© mĂ©dicale.

Cette injustice sociale est doublĂ©e d’un non-sens Ă©conomique complet : tous les spĂ©cialistes de santĂ© publique savent qu’il faut faciliter financièrement le plus possible l’accès au mĂ©decin de premier recours - c’est-Ă -dire le mĂ©decin gĂ©nĂ©raliste - car les diagnostics et les traitements prĂ©coces, susceptibles d’Ă©viter qu’une maladie ne devienne grave - donc chère - constituent le premier facteur d’Ă©conomies des dĂ©penses de santĂ©. C’est pourquoi, dans la plupart des pays dĂ©veloppĂ©s, l’accès au mĂ©decin gĂ©nĂ©raliste est dispensĂ© de toute avance de frais et de franchise ; il est absurde de dissuader financièrement ce que les considĂ©rations de santĂ© publique et d’Ă©conomies de santĂ© devrait inciter Ă  encourager !

La seule responsabilisation financière possible serait celle des ordonnateurs des dĂ©penses, c’est-Ă -dire des prescripteurs... celle que Nicolas Sarkozy Ă©carte d’office : " La mĂ©decine libĂ©rale, qui ne reprĂ©sente que 15 % des dĂ©penses, a fait beaucoup d’efforts ". Je ne vois pas lesquels, en dehors des combats facilement gagnĂ©s par les spĂ©cialistes pour obtenir des droits quasi constants aux dĂ©passements d’honoraires, et dont le montant vient s’ajouter Ă  la franchise financière pour majorer d’autant la part laissĂ©e Ă  la charge des malades.

Il convient de rappeler ici :
- qu’entre 1990 et 2004, le revenu des mĂ©decins spĂ©cialistes a progressĂ© trois fois plus vite que celui des salariĂ©s, selon le prochain rapport du Haut conseil pour l’avenir de l’assurance-maladie (HCAAM), attendu cette semaine, et qui illustre le fait que les efforts financiers ont toujours Ă©tĂ© demandĂ©s aux seuls salariĂ©s ;
- qu’en Allemagne, le montant des honoraires mĂ©dicaux est fixĂ© en fin d’annĂ©e, en fonction des comptes de l’assurance maladie : en cas de dĂ©ficit, il est abaissĂ©, et les mĂ©decins doivent rembourser le trop-perçu, compte tenu des nouveaux tarifs Ă  effet rĂ©troactif (système dit des " lettres clĂ©s-flottantes ").

Mais, ces cinq dernières annĂ©es, le gouvernement a Ă©tĂ© tĂ©tanisĂ© par son obsession d’Ă©viter de mĂ©contenter de quelque façon que ce soit les mĂ©decins ; ce qu’on peut appeler son "syndrĂ´me plan JuppĂ©", auquel il attribue son Ă©chec aux lĂ©gislatives de 1997.
L’exemple de l’Allemagne montre pourtant qu’une rĂ©forme de l’assurance maladie, nĂ©cessairement douloureuse, ne peut rĂ©ussir que si les sacrifices sont Ă©quitablement rĂ©partis entre les assurĂ©s, les professionnels de santĂ© et l’industrie pharmaceutique : en choisissant, pour des considĂ©rations aussi Ă©lectoralistes qu’idĂ©ologiques, de favoriser ces deux dernières catĂ©gories et de faire porter tout le poids financier des rĂ©formes aux seuls assurĂ©s, Nicolas Sarkozy opte pour une mĂ©decine de classe et prĂ©pare une situation socialement explosive.

[1] D’après la prĂ©sentation de Michel Sorin pour MRC53 en prĂ©ambule Ă  cette contribution d’Elie AriĂ© pour OpiMed, Ă©galement publiĂ©e par l’HumanitĂ©, Ă©dition du 25 janvier 2007, sous le titre : "On ne choisit pas d’ĂŞtre malade".

[2] Interview publiée dans Le Monde daté du 23 janvier 2007.


Tweet
 


Répondre à cet article


Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

Warning: preg_replace_callback(): Requires argument 2, 'chr('\1')', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 166

Warning: preg_replace_callback(): Requires argument 2, 'chr(hexdec('\1'))', to be a valid callback in /home/medecine/www/opimed/ecrire/safehtml/classes/safehtml.php on line 167

5 Messages de forum


Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191

Deprecated: Function ereg_replace() is deprecated in /home/medecine/www/opimed/ecrire/inc/indexation.php on line 191