In France, the Social Security financing bill for 2024 was tabled before the National Assembly on 27 September 2023. The article by the French Administration outlines the measures provided under the bill.
The Social Security financing bill (PLFSS) for 2024 was presented to the Council of Ministers on September 27, 2023. It was tabled on the same day on the desk of the National Assembly and should be discussed in plenary session at from October 24. This bill contains in particular measures relating to improving access to care; preventive actions; loss of autonomy and disability; and the fight against social fraud.
Medications delivered individually in the event of a supply shortage
The bill plans to generalize the individual dispensing, by community pharmacists, of medications affected by a supply shortage. An order from the Minister responsible for Health may thus make it compulsory to issue medications to the unit in the event of a disruption in their supply; and another decree will put an end to this measure when it is no longer necessary.
In the event of a supply disruption, the Minister responsible for Health may also, by order, limit or prohibit the prescription via teleconsultation of certain medicines concerned, in particular antibiotics.
Limitation of the duration of work stoppages prescribed in teleconsultation
The PLFSS 2024 provides that it is no longer possible to benefit from a teleconsultation from a work stoppage lasting more than 3 days or from the renewal of a work stoppage. Two exceptions are provided:
- prescriptions made by the attending physician;
- and if the patient proves it is impossible to obtain a face-to-face consultation for the renewal of his sick leave.
It was estimated that prior knowledge of the patient, their history, their state of health and their environment allows treating doctors, even without a physical examination, to be able to assess the situation via teleconsultation.
Strengthening controls on sick leave
Concerning sick leave, it is proposed in the bill to strengthen the control capacities of primary health insurance funds and employers; and to increase sanctions in the event of work stoppage that is not, or no longer, medically justified.
The payment of daily allowances may be automatically suspended as soon as the report of the medical inspector, mandated by the employer, concludes that sick leave is unjustified. The insured persons concerned will have recourse to the medical service.
Treatment of cystitis and tonsillitis by pharmacists
The bill proposes that pharmacists be authorized to dispense antibiotics for simple tonsillitis and cystitis without a prescription, after carrying out a test to confirm the bacterial origin of the disease.
Patients suffering from a sore throat or burning when urinating will be able to go to a pharmacy, carry out a test and be given an antibiotic directly.
Evolution of the prevention appointment system at key ages of life
Prevention appointments at different key ages of life were created by the Social Security financing law for 2023. Each insured person must be offered three free medical visits by Health Insurance at ages 25, 45 and 65. in order to take stock of their physical and mental health and implement appropriate care if necessary. The objective is to strengthen the health of adults and prevent the appearance of chronic diseases, in particular through raising awareness and adopting lifestyle habits favorable to health.
The PLFSS 2024 specifies that these assessments can be carried out by different health professionals (doctors, nurses, midwives, pharmacists) trained for this purpose. The measure contained in the bill indicates that health professionals cannot charge excess fees for these prevention appointments.
The fight against menstrual poverty among women under 26 and the most vulnerable
Menstrual poverty (the difficulty encountered by women in purchasing sanitary protection because of their low income) today concerns nearly 31% of menstruating women aged 18 to 50 and 44% of 18-24 year olds in France, according to an Opinionway survey published in March 2023.
The bill provides for the reimbursement of reusable menstrual protection (pants and menstrual cups) for insured persons under the age of 26, as well as for beneficiaries of complementary solidarity health insurance (C2S) with no age limit.
Insured persons under the age of 26 will benefit from 60% coverage by Health Insurance and their participation may be compensated by complementary organizations. C2S beneficiaries will benefit from 100% coverage for these hygienic protections.
A referencing procedure, based on specifications, will be implemented to ensure the quality of the products. The availability of the products will initially be organized in the pharmacy.
Free condoms, without a prescription, for everyone under 26
It is proposed, in the PLFSS 2024, to enshrine in law 100% coverage by Health Insurance for the delivery in pharmacies, without a medical prescription, of condoms to young people under 26; This measure has already been implemented by health insurance funds since January 1, 2023 .
Only condoms listed on the list of products and services reimbursable by Health Insurance (LPP) can be issued. For the moment, two brands of condoms are listed on the LPP; registration requests are in progress.
Facilitating access to complementary solidarity health insurance
Supplementary solidarity health insurance (C2S) offers policyholders with modest incomes extended protection, guaranteeing coverage for an extensive basket of care, without advance costs and without excess fees. Depending on the household’s resources, this supplement is available free of charge or in exchange for a financial contribution. Many beneficiaries of minimum social benefits, although most of them are eligible for C2S, do not use this system.
It is proposed, in the PLFSS 2024, the establishment of a presumption of right to complementary solidarity health insurance with financial participation for most beneficiaries (subject to meeting certain criteria):
- the allowance for disabled adults (AAH);
- supplementary disability allowance (ASI);
- the specific solidarity allowance (ASS);
- and the youth employment contract allocation (ACEJ).
When they are allocated the social minimum to which they are entitled, the compulsory health insurance funds will send them a letter offering them the opportunity to benefit from paid C2S, without them having to declare their resources.
Additional means for the autonomy of the elderly
Home nursing services (SSIAD) provide care to the elderly and people with disabilities; they also ensure coordination with other medical and paramedical stakeholders (home help services, physiotherapists, doctors, etc.). SSIADs are authorized to intervene with a limited number of people and in a specific geographical area.
The PLFSS 2024 provides additional resources for the creation of new places for home nursing care services, as well as for financing an increase in the number of professionals working in EHPADs.
An early support service for disability situations
Late diagnosis of developmental disorders can be a source of additional handicap and loss of opportunity for the child. This results in a loss of autonomy ultimately requiring more care and significant support throughout the life of the person with a disability.
It is proposed, in the PLFSS 2024, that a service be set up intended for all children under 6 years old, regardless of their disabilities or suspected disabilities, by creating an assessment, diagnosis and intervention pathway. .
This service will have the mission of supporting families with children affected in particular by:
- neurodevelopmental disorders;
- cerebral palsy;
- a multiple disability;
- or a sensory disability.
This system should make it possible to bring together existing structures in this area to make a care and support offer that is currently fragmented coherent.
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