Access to the cares and continuity of the medical cares
Measure relating to politics of demography medical software:
The projections underline that the decrease of medical density increases the importance of a politics of regulation installation of the doctors on the territory in order to lessen the unequal distribution of the doctors and Correlative the inequality of access to the cares.
In partnership notably with the State, the territorial groups and the universities of medicine, the parties Signatories wish to be an actor of a politics of regulation. Here and now, the signatory parties agree on the Fact that the financial assistance to them only will not allow resolving the problem of the installation of the doctors in loss-making zone that supposes an improvement of the conditions of exercise.
To this title, they suit to adopt, previously, destined measures to favor the replacements in the rural zones or loss-making urban in care offer. In a second time, a measure incitive bouquet elaborated in collaboration with the body of the actors concerned will be implemented; the parties agree to study notably the placement at the disposal of a “title job business” to the registered doctors.
Measure relating to the replacement of the nonspecialist doctors: The one of the principal constraints evoked by the professionals of exercising health in rural zones, of mountain or loss-making urban in care offer is, besides the permanence and the continuity of the cares, the difficulty of itself do replace. The signatory parties suit previously to implement the contracts of good carrying practice management software on the concerned zones.
Another measures aims to accompany the doctors installing themselves or installed in loss-making zone of cares. To this effect, the UNCAM is involved itself to implement tools, for example a site internet, allowing him to simplify for the doctors of these zones the research of substitutes.
Tools and supplementary works:
In parallel of these disposals, the signatory parties are involved themselves to study the implement tools allowing supplementary the doctors, making the choice to install itself in loss-making zones, to profit of a specific and adapted accompaniment, in order to implement a politics of regulation demographic founded on a partnership and incitive devices taking account of the needs expressed by the general practitioners.
In this field, works will be started, carrying notably on the four following shutters of action: The possibility of granting of a stock market of studies to the students in medicine being involved itself to install itself in a zone loss-making, in complement and/or in supplement, of the one that eventually could be offered by the territorial groups.
The development by the disease insurance of a gait of offer of services to the professionals installing themselves. The service offer would allow notably to help the doctors to establish a study of market of the zone where they wish to install themselves and to accompany them in the relevant administrative gaits to their installation. It would be a question also to inform them on the medical houses, the networks, the methods of organization of the permanence of the cares, etc. existing in the zone where they wish to exercise. This will be able to be accompanied of a gait of information of the students in medicine within the universities on the installation and even generally on the disease insurance.
The possibility of assistance forfaitaires to the installation. The signatory parties will study of here to the 1st January 2006 the eventual methods of granting of assistance in the field foreseen by the item 49 of the law of August 13 2004 relating to the disease insurance.
The signatory parties are involved themselves to realize, in the current of the year 2006, a report of the conditions of access of the assured to the coordinated cares to tariffs opposables or mastered and to study, as of need, the measures likely to guarantee to the body of the assured this access, in particular in the zones of weak density.
Medical Software.
The permanence of the outpatient cares: The signatory parties agree to put to profit the publication of the new statutory texts to define the device of permanence of the cares; this new device will be specified in a conventional avenant, to the more late March 15 2005. The statutory modifications awaited should allow the adaptation of the organization of the permanence of the cares the night, according to the need and possibilities of response, therefore of relay, that exist or can be set up on a given sector, in particular between midnight and 8 hours. The signatory parties will optimize the intervention of the doctors, notably when they are permanence in second party of night, in order to take into account the different systems of response to the night urgencies,
Notably the hospital urgencies. Will equally be taken into account the special case of the rural zones distinguished of the urban zones in which ones the offered responses to the population to the need of permanence of the medical care are diversified.
From that time, will be able to be set up a regional management of the device of permanence of the outpatient cares in the framework of the regional missions of health on the basis of a global envelope that will be attributed them. While waiting for a new conventional agreement, the current device continues to apply; the parties signatories agree to reserve an envelope of 60 million Euros for the implement of this future device of permanence of the outpatient medical records.
The permanence of the cares in establishments:
While waiting for an examination of the position of the other specialists subjected to the same obligations of permanence in establishment, the presented disposals to the following paragraphs are resumed. The signatories suit to study, all particularly, the position of the paediatricians subjected to obligations of obligation, as well as the one of the doctors emergency physicians subjected to obligations on duty in private UPATOU.
Professional practices of the surgeons and anesthesiologists reanimates, relating to the permanence of the emergencies: In order to organize their professional practices relating to the permanence of the urgencies, the surgeons and anesthesiologists réanimateurs that assure the taken in charge of the urgencies within the health establishments mentioned to the d of the item L. 162-22-6 code of the social security authorized to let a unity work or a service of urgency or within an authorized establishment to work an establishment relay in conformity to the item R. 712-69 of the code of public health can adhere to contracts in accordance with the typical contract in annex. The liberal doctors in establishment relay cannot perceive preceding remunerations when they them already perceive to the title of their intervention in establishments having received an urgency authorization. Professional practices of the gynecologists obstetricians and anesthesiologists réanimateurs, relating to the taken in charge of the deliveries in more than 1 practicing obstetrics unities 500 deliveries:
In order to organize their professional practices relating to the permanence of the taken in charge of deliveries in more than 1 practicing obstetrics unities 500 deliveries, the gynecologists obstetricians and the anesthesiologists réanimateurs exercising in a mentioned unity to the item D. 712-75 of the code of public health can adhere to contracts in accordance with the typical contracts in annex. Remuneration to which open right these contracts does not accrue with the increase forfaitaire for special sujétion mentioned in the stopped the 27 December 2001.
Professional practices of the paediatricians, relating to the permanence of the supervision and of the taken in load with the specialized cares of certain newborn ones: In order to organize their professional practices relating to the permanence of the supervision and of the taken in load with the specialized cares of the newborn ones to risk and of those of which the state is itself layered after the birth or present of distresses engrave or vital risks, the paediatricians exercising in mentioned unities to the item D. 712-90, under reserve to practice the intensive cares of néonatologie, and to the item D. 712-98 of the code of the public health can adhere to contracts in accordance with the typical contract in annex. Remuneration to which open right these contracts does not accrue with the increase forfaitaire for special mentioned subjection in the stopped December 27 2001.
Professional practices relating to the permanence of the taken in charge of patients presenting several visceral failures putting in game the vital prediction and implying the recourse to methods of supplicant: In order to organize their professional practices relating to the permanence of the taken in charge of patients presenting several visceral failures putting in game the vital prediction and implying the recourse to the methods of suppléance, the doctors specialists mentioned to the item D. 712-108 of the code of public health exercising in a mentioned unity to the item D. 712-106 of the same code can adhere to contracts in accordance with the typical contract in annex.
Professional practices relating to the permanence of the taken in charge of the cardiological intensive cares : In order to organize their professional practices relating to the permanence of the taken in charge of the cares radiological intensive, foreseen to the item D. 712-117 of the code of public health, the doctors exercising in the mentioned unities to the item D. 712-115 of the same code can adhere to contracts in accordance with the typical contract in Annex.
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