Tele-health services: some doctors continue to resist

While most doctors have been using telemedicine services for health insurance for about ten years, some still refuse to use them.

"Guarantee to insured persons an adapted care". This is the promise of the Health Insurance on the online services it has developed for health professionals since 2011. However, if the majority of doctors today use these services accessible to all, some irreducible still refuse to serve . But why?

The rumbling started in 2014. That year, the syndicate of GP MG France had called practitioners to stop using tele-services to make work stoppages. Because this "allows the CPAM to multiply these control maneuvers on objectives against doctors," he explained on his website. Authorities accusing doctors of distributing erroneously through work stoppages that plague French finances, "some health insurance funds took the opportunity to launch, without any consultation, a vast campaign of guilt only general practitioners about their prescriptions of work stoppages ", was it written in particular.

That is why, "the union MG France recalls that it recommends to each doctor concerned to refuse the procedure known as" putting under objectives "and to get closer to his departmental managers upon receipt of the first mail. doctors in France to immediately stop the use of the tele-service "sick leave online" which allows the CPAM to multiply these maneuvers at the expense of the doctor, "concluded the release.

"It's up to the patient to get reimbursed"

Even today, hostility remains the order of the day. In May 2018, thousands of doctors still refused to use the Vitale card, believing that they did not have to do the work of the Health Insurance in its place. "We must let the doctor do only medicine, the rest is not his problem, it is the patient to fend for reimbursement", testifies to AFP a Parisian gastroenterologist interviewed on the topic.

"I do not like being flirted and I have never accepted a Vitale card, which turns doctors into employees of insurance funds, while pushing patients to medical over-consumption due to non-payment," adds a generalist in the Channel. "If my patients told me that it is very boring, I would line up, but they do not criticize and do not refuse to pay me directly," says a gynecologist in Côte d'Or, who has been practicing for 40 years.

"There is a group of health professionals who feel they are too close to their end of activity to embark on computerization or teletransmission," said Pierre Peix, director of operations of the CNAM (National Insurance Fund) Disease). "Some doctors are chilly to use these tele-services, they may not feel that it will be a time saver," said his side Dr. Elbaz, general practitioner in the Paris region invited in our program Tele-health services: to better help patients, himself a great fan of tele-services.

What do we do with medical data?

But beyond the old school side VS new school aspect, arises the question of patient data. Indeed, some suspicious doctors wonder who does this information once it is transmitted over the Internet. Can a banker access the health diagnosis of his client and refuse him a credit? "All the transmission is secure, from the post with the health professional card to the Health Insurance server.On the second element, all data processing is framed from a regulatory point of view, in accordance with the CNIL And finally, at home, people who access sensitive data are entitled to medical services.Everyone does not have access to everything, we are very vigilant, "says Dr. Annika Dinis, director of the Tele-services program. Healthcare professionals at CNAMTS (National Fund for the Health Insurance of Employees).

Finally, sometimes, these are practical reasons that prevent some doctors from using tele-services. In fact, generalists may not have access to certain offers because of the disparity of the plans. With the MGEN for example, it is impossible to use tele-services for sick leave. "In the beginning, we had tele-services exclusively adapted to the general system and for some time we have been working with all the plans to offer these tele-services, but each regime has to do technical operations in their computers and upset their organization. (...) We will, in the coming months, find solutions so that when a doctor arrives on a tele-service, he no longer asks the question of whether or not he can do it for a particular patient ", promises Dr. Dinnis.

In the meantime, it is especially tele-consultation that worries doctors. While the latter became widespread in September across the French territory in the hope of solving the problem of medical deserts, the Health Professionals Mutual Insurance Company conducted a survey among health professionals to have their opinion on the issue. Result: 73% of them (including 82% of GPs) fear a gradual "dehumanization of care" via this system of meeting a patient through a computer.

Here's the complete program Tele-Health Services: Helping Patients Better

Video: Scope of practice regulation and health care reform. LIVE STREAM (February 2020).