Paris (AFP)
At the edge of the coronavirus epidemic, the government decided to open wide the gates of teleconsultation, following in the footsteps of telemedicine platforms, even if the medical unions are divided on this strategy.
"A decree to soften"
Olivier Véran announced Sunday that he would sign "tomorrow (Monday, note) a decree to considerably soften the conditions for carrying out telemedicine", in order to "simplify the access of patients to a doctor in teleconsultation".
The Minister of Health notably "decided to lift the obligation to go through his attending doctor and to have had a face-to-face consultation the 12 months before carrying out a remote consultation".
Since it is reimbursed by the Social Security (September 2018), teleconsultation must indeed be prescribed and performed by practitioners already known to the patient, as part of the "coordinated care pathway".
However, there are many exceptions, for children under 16, "direct access" specialists (gynecologists, ophthalmologists, pediatricians ...) and people who "do not have a designated attending physician".
This derogation also applies to all those "whose attending physician is not available within the period compatible with their state of health".
A formulation that is vague enough that any insured person could in theory "have access to a teleconsultation when he needs it" as Mr. Véran wanted.
Platforms on the lookout
Several telemedicine platforms preceded the minister's announcement and proposed last week free access for doctors to their teleconsultation services.
The essential Doctolib thus offered as of Thursday "to all the doctors of France to use the video consultation free", starting with its 3,500 subscribers, who had until then had to pay 79 euros per month.
For other practitioners, the company also undertook to finance "fully the costs of equipment (and) training".
On the same day, its competitor CompuGroup Medical, a German publisher of medical software, announced that its "teleconsultation solution" was "made available free" for "all doctors, in France and in Europe" for "the entire duration of the 'epidemic".
Friday, the Consulib company communicated in turn on "free service (...) instead of the fee of 1 euro usually charged by consultation".
The final bill (25 euros for a general practitioner) remaining the responsibility of the Social Security and complementary health, the health crisis is also a boon for those who have been waiting for 18 months for the rise of telemedicine in France.
So far, takeoff has been slow: Health Insurance totaled 138,000 acts reimbursed between September 2018 and the end of 2019, including 30,000 for the month of December alone.
Divided medical unions
Although it favors platforms, the use of teleconsultation was first demanded by liberal doctors.
At the end of February, the union of specialists Avenir Spé thus demanded its "massive deployment", in order to "avoid the overcrowding of emergencies and calls to the Samu" and to "limit the spread" of the coronavirus.
On Friday, their colleagues from the Specialists-CSMF considered "imperative that the monitoring of patients can be carried out", among others, "by teleconsultations".
On Monday, FMF generalists were in turn encouraged to "go on teleconsultation for many situations", such as refilling prescriptions "in patients who are doing well" or work stoppages "including for patients Covid-19 suspects who are mildly symptomatic. "
But at the same time, MG France warned: teleconsultation "is not a quick fix" and it "increases the risk in decision-making".
Faced with a coronavirus particularly lethal for the elderly and the chronically ill, "the prior knowledge of these patients by their treating physicians is a major asset for their health," said the first generalists' union, calling on the government not to " sweep the railings difficult to put in place ".
© 2020 AFP