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Coordinated care pathway: private doctors divided

Kiosk360. According to the new health reform, patients must first go to a general practitioner before going to a specialist. This is called the coordinated care pathway and this provision does not appeal to medical specialists at all. Explanations in this press review taken from the weekly La Vie Éco.

The draft framework law relating to the reform of the health system has not yet been voted on and is already causing controversy. According to the weekly Eco Lifewhich addresses this subject in its edition of Friday, September 23, it is particularly the provisions relating to the establishment of a course of coordinated care (PSC) which, at the same time, irritates and divides the practitioners of the liberal sector.

Article 12 of this draft framework law states, in fact, that a patient from the liberal sector “must imperatively go through a general practitioner”. This obligatory passage does not pass at the specialists. However, it is the framework of this system which will be generalized once this law has been adopted. The weekly speaks, precisely, of generalization since the PSC has already been in force in the public sector since 2007.

Logically, if it is duplicated in the private sector, it is because it has proven itself in the public. On paper, the patient first goes to the health center in his district. This is where he receives first aid. If his case requires it, the centre’s doctor will refer him to a specialist in the provincial hospital or even at the university hospital. In reality, patients prefer to skip the steps and go directly to the CHU.

In short, beyond the fact that this circuit makes it possible to accompany and guide the patient, to manage the medical file, to ensure, in coordination with the medical specialist, the treatment protocol for a long-term illness, among other things, it also allows significant savings in money and time. Indeed, according to the weekly, the PSC will avoid the multiplicity of consultations, drug prescriptions and medical examinations. It therefore allows the control of health care expenditure for households and the rationalization of expenditure for social security funds and mutual insurance companies.

Obviously, all this does not seem to convince the private sector practitioners who have organized an outcry against this article. According to an oncology specialist quoted by the weekly, “the passage to a general practitioner or a general practitioner could lead to a loss of time and a delay in diagnosis. Delay which could be serious, even fatal”. Another specialist, a gastrologist this time, also taken over by Eco Life, confirms: the passage by a PSC “would result in the loss of a significant number of patients who could be satisfied with a follow-up with a general practitioner”. All is said, the real concern of the detractors of this circuit is that they are afraid of losing their patients.

Oncologists, gastrologists, rheumatologists, cardiologists are almost all against the prospect of setting up this PSC. Naturally, there are specialists that this eventuality does not affect. For obvious reasons, one cannot go to a general practitioner before going to an ophthalmologist or a pediatrician, just as a woman will go directly to a gynecologist without going through a general practitioner. In these cases, the problem does not arise.

In short, to get out of the impasse, according to the specialists, the general practitioners must direct, from the first consultation, the patients to a specialist. According to the weekly, this is already the case. Quoting this time an association of doctors from the liberal sector, the weekly affirms that, normally, as soon as the doctor detects a problem at the level of the heart, the lungs or other organs, he directs the patient to a specialist.

This saves time and limits healthcare costs. Except that, according to the same source, “very often, when a general practitioner sends a patient with complete assessments to a fellow specialist, the latter asks him to redo all the examinations. And this is where we are faced with a waste of time and money too”.


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