Medical deserts : from the concrete to the physicians, outstanding issues for telemedicine

How to move toward “equal access to health services in the territories ?” On a trip to Chalus, Haute-Vienne, for the inauguration of a health house, on Friday 13 October, the minister of Health, Agnes Buzyn, and the Prime minister Edouard Philippe have unveiled a plan to answer this question, of which the first two priorities are telemedicine and the development of the offer of care.

For the latter, classified as priority number 1, the government hopes to foster the presence of doctors in areas with low medical offer. He announced a catalogue of measures financial incentives in this plan. They cater to a large number of profiles, the young house physician close to retirement.

In order to encourage doctors to practise in the medical deserts, Agnès Buzyn and Édouard Philippe have announced € 50,000 to aid conventional over 3 years for the installation of a doctor in a region that is under-density medical. The government will also contribute to cumulative employment/retirement for physicians wishing to exercise longer. The latter may be exempt from contributions to the plan top-up Benefit age up to a threshold of € 40,000 of income, compared with 15,000 today, in the areas that will be deemed to be under-medicalized. The government will work in 2018 to (re)define these areas.

Another measure to encourage the occasional transportation of doctors in “areas under-dense”, a revaluation fee of 25% up to € 20,000 of revenue from these activities.

Finally, the government will enhance the value of compensation of the supervisors present in the medical deserts of 50% (or 300 euros).” The purpose of this ? Encourage them to take under their wing internal trainees. The latter can potentially benefit from financial aid to housing and transport.

These measures should help to fill the new health houses, which he wants to double the number there are 910, according to a senate report, recent, and 330 in the project.To achieve this, the government will invest 400 million euros here during the quinquennium. The first euros will be released at the end of the year.

The doctors are very pleased with the absence of coercive measures

Doctors ‘ organisations have been enthusiastic as a result of these ads. The ones who were almost constantly defiant against Marisol Touraine, the previous minister of Health…

Several trade unions of the liberal doctors were satisfied, like the independent Group of generalist youth (Reagjir) and the Confédération des syndicats médicaux français (CSMF). The first trade union medical “welcomes the absence of coercive measures to the installation of the doctors”. He rejoices in the addition of the “incentives to the installation,” which “will reduce es the inequalities of access to care. The government has understood”.

Blur on the structure of the offer in telemedicine

However, Edouard Philippe and Agnès Buzyn believe that this will not be sufficient to address the problem of medical deserts. Today, 8% of the population -more than 5.3 million people – resides in a common under-dense by general practitioners, in the sense of an accessibility less than 2.5 consultations per year and per capita, according to the latest figures from the Drees, published in may of 2017. They have, therefore, established as the second priority on the development of telemedicine.

In this area, the measures announced are less detailed and could be put in place painstakingly. First of all, negotiations treaty will be put in place to “define a pricing for teleconsultation and tele-expertise”. These “may as well have a rate prior to the summer 2018”, hopes the government.

Moreover, in order to equip all long-term care facilities and facilities for areas of dense devices, telemedicine, the appropriations of the response fund regional (FIR) ad-hoc “will be doubled in 2018 to spend 18 million euros,” or about 28 000 euros per establishment. The objective of the government is to resort to the telemedicine and in particular to “avoid unnecessary hospitalizations and improve the quality of the follow-up of patients”.

However, it is not clear whether these tools of tele-consultation will be used to all the specialties possible and imaginable of telemedicine. And overall, the future structure of the supply of telemedicine remains unclear. The PLFSS 2018 plans to put “an end to the experimental nature of the telemedicine”. The government, however, will not come out of the experiments immediately. He still wants to study the project and “trust all players in the territories to build projects and innovate”, with “a regular assessment of the implementation of the different actions territorial”, through a “national follow-up committee of local actions”. A perspective that could avoid the usage of unnecessary. As explained to The Tribune several actors involved in telemedicine, a number of acts of medicine at a distance may prove to be unnecessary, according to criteria for medico-economic. The other hand, experiments in telemedicine are already being carried out since many years and are slow to be implemented on a national scale, as pointed out by the Court of accounts…

Blur on the democratization of the DMP, online appointment scheduling,…

Always in the digital health, other areas were mentioned Friday that the journey to produce either detailed. Thus, the government plans to generalize the personal medical dossier (DMP), which is slow to democratize (less than a million people have this file, which allows healthcare professionals access all medical data of a patient).

No details on how to generalize “the possibilities of appointments in line” or on the development of the “compatibility of software”, a measure of simplification that can avoid duplication and additional costs in the course of the patient.

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