In Aude, there are 70,137 insured persons with long-term conditions. Among them, 5,777 patients who have recently benefited from care are without an attending physician, ie 8% of the ALD insured persons of the Department’s Health Insurance. A figure that the CPAM wants to see tend towards zero.
Under the dual effect of changes in medical demography and the aging of the population, the number of people suffering from a long-term condition (ALD) without a general practitioner in France rose from 510,000 at the end of 2018 to 714,000 at the end of 2018. 2022. Without action, this figure would continue to increase and could reach 800,000 people at the end of 2023. In Aude, 70,137 insured are in ALD (figure of January 1, 2023).
Among them, 5,777 so-called “consuming” patients (having received care during the year) over the age of 17, are without a attending physician. That is 8% of ALD policyholders from the Primary Health Insurance Fund (CPAM) of Aude.
The Minister of Health and Prevention, François Braun, has instructed the health insurance services to build and deploy “an action plan with immediate effect” to provide solutions for these people and reduce the number of patients with ALD without a treating physician. “The ‘ALD without attending physician’ scheme aims to break this dynamic and to offer support to all the patients concerned by the end of the year. In particular by putting the attending physician at the heart of the care pathway”argues Pascale Sejalon, health / prevention support mission manager at the CPAM de l’Aude.
How ?
The action plan is based on three key principles. The first stage, which took place last April, consisted of contacting all insured persons under long-term care without an attending physician “in order to offer them to be accompanied in the connection with a treating doctor”, says Karine Boissin, health support mission collaborator at the CPAM audoise.
The second step: identify ALD patients aged 17 and over who have consulted the same doctor three times during the year, without the latter being declared as their treating doctor. “The Aude Health Insurance will send each doctor the list of ALD patients he sees at least three times a year without being their attending physician, inviting him to agree to become one. This plan of action is based on the voluntary work of the doctor and his free choice, according to his own possibilities of following new patients as a treating doctor”underlines Marianne Falandry, referent coordinated organizations and person in charge for territorial animations with the CPAM.
Financial incentive
And finally, last step: the deployment of the territorial dynamic, the system based on the recognition of the reality and the diversity of the territories, taking into account the density of health professionals, the population concerned but also the actions already engaged in the field. “The role of the professional territorial health communities (CPTS) is essential. Access to care is a priority mission for these organizations which are already working there. They have a role to play in mobilizing all the doctors in their territory”, would like to underline Stéphanie Horala of the CPAM.
To encourage doctors to get involved in the process, the arbitration rules provide for the setting up of a consultation increased to €60 for the registration as treating doctor of a new patient in ALD.