François Braun’s plan for the follow-up of the chronically ill

Will this be enough to help the many chronically ill people who cannot find attending physicians? “I can’t get the prescriptions to renew my treatment, so I buy it on the Internet”, testifies, for example, Sébastien (1). Like nearly one in three French people, he suffers from high blood pressure. Since he moved to Challans (Vendée) two years ago, he has not found a doctor and has had difficulty renewing his treatment. “All the surgeries around are full, so I stopped looking,” admits the father of the family.

Like him, 714,000 chronically ill people find themselves without a doctor. A situation against which the Minister of Health announces a plan of unprecedented magnitude. “The chronically ill are more and more numerous, and this figure will only increase, justifies François Braun. Apart from the vaccination strategy against Covid-19, the launch of this plan constitutes the largest “going-towards” operation that has taken place. It will allow us to solicit patients who are far from our health system. The health insurance funds will be at the center of the patient-doctor linking system designed by the ministry.

“Soliciting patients who are remote from our health system”

This effort will be done in stages, starting this March. First of all, at the level of each territory, the Cpam will send a letter to all patients with long-term illness (ALD) without follow-up in order to offer them help in finding a doctor. Then, the Cpam will address generalists.

Those who see a chronic patient three times a year for whom they are not the attending physician will be offered to follow them, with an advantage, since an attending physician receives – in addition to the price of consultations – €70 per year for each patient ALD for over 80s and €42 for those under 80. The goal ? Reach one-third of chronically ill patients without an attending physician who nevertheless see a practitioner regularly.

“The agents of the primary funds are very motivated”

The workload of doctors will also be taken into account. “Physicians are already devoted to their patients. Our collective challenge is not so much to work more than to support doctors with new tools and new organizations to enable them to take care of more patients”, specifies François Braun. Also, among GPs who do not see regular chronic patients, those with a patient base of less than 1,020 patients will be approached first, followed by those who work with a medical assistant or a nurse.

Once these letters have been sent, in June, the various data will be transmitted to the professional territorial health communities (CPTS) – which bring together local health actors – and to the Cpam, so that they can find a solution adapted to each patient. Contacts will be made primarily by the CPTS, but the agents of the primary funds will also be able to take over if necessary, which would correspond to their expectations. “The agents of the primary funds are, in fact, very motivated by the fact of being able to carry out concrete work to help people”, argues the Minister.

“It’s not about doing administrative matching”

In all cases, patients will remain free to choose their doctor and the latter to refuse a new patient. “This plan is based on a free acceptance of the different parties,” admits the minister’s office. Also, after a first meeting with a practitioner, the patient may refuse to join the patient of the latter, and vice versa. “It is not a question of making administrative matching”, insists the ministry.

Among the ALD patients without follow-up, some fear, in fact, to be put in contact with a doctor several kilometers from their home. In the territories which lack the most practitioners, “mobility aid could then be put in place”, specifies the cabinet of the ministry.

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The chronically ill, a challenge for the health system

In France, nearly 15 million people are affected by chronic diseases. Among them, 600,000 people do not have an attending physician.

Diabetes concerns more than 3.6 million people in France and is expected to reach more than 783 million adults worldwide by 2045.

According to a study by DREES, they affect people with low incomes more.

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