On the front line as a payer, the National Health Insurance Fund (Cnam) enters, with the deconfinement, into a much more operational phase by creating a health brigade responsible for tracing any person contaminated with Covid-19 and inciting its screening contacts. A new and sensitive device to be launched this Wednesday and that Nicolas Revel, director general of the Cnam, details us, before mentioning the incredible success of teleconsultation and the huge bill for health insurance that will be necessary honor well.
Because of referral to the Constitutional Council on the law extending the state of health emergency, you had to postpone the establishment, scheduled for May 11, health brigades and the tracking of contaminated people. What does the decision of the court rendered on Monday evening change?
NICOLAS REVEL. His main reservation concerned the consent of people to have their contact details given to social teams who could help them during their isolation. We obviously take it into account. The system could not start until the law and its decree were published. This will normally be the case this Wednesday. We will start immediately.
You have created "health brigades". What is their role in relation to doctors?
The only way to break an epidemic is to break the chains of contamination. We achieved this during these two months of confinement. Since May 11, we must continue to act, but focus on people at proven risk: those who have contracted Covid 19 and those who have been in contact with them. The essential starting point is the doctor. It is he who must prescribe PCR tests and manage the patient and his family. It is he who must enter on our Contact Covid portal the maximum of elements allowing us to identify the contact persons. Then, the health insurance brigades will take over.
Who composes them and what access to personal data?
They are made up of 6,500 employees, all employees of health insurance. They are doctors, nurses, advisers specializing in support and contact with insured persons ... There will be some in each department, available seven days a week, from 8 am to 7 pm. They are all bound to medical or professional secrecy. Their role will be to identify the contacts of the infected patient, go up the chain and inform them all of the risk. The name of the infected patient will only be given with their consent. Our agents must disseminate the instructions: first isolate themselves, go for screening, protect their loved ones. We are not constrained but in an incentive and support process.
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And sick leaves, masks, tests… Who prescribes?
If sick leave is required, we will prescribe it. For masks and tests, pharmacists and biologists will check directly on the Ameli portal that the person is registered as being able to benefit from it. No need for a paper prescription, and everything will be covered 100%.
The Order of Physicians has issued a warning regarding the respect of medical confidentiality. Is it guaranteed?
Yes, absolutely! Guarantees were given to the Order, which also communicated on Tuesday to officially support the device. Health insurance shares health data with doctors and patients every day: long-term illnesses, work stoppages, prescriptions, etc. This is why we have been entrusted with this device.
Will the serological tests be reimbursed?
Today we use virological tests which are 100% reimbursed. Our capacity is increasing sharply, with 700,000 tests per week. The most important thing is that anyone who needs to be tested is tested quickly. Regarding blood tests, we are awaiting a new opinion from the French National Authority for Health (HAS) to decide on their reimbursement.
How many teleconsultations are there and will you maintain their reimbursement at 100%?
The number of teleconsultations has stabilized around one million per week. It is considerable. I note with satisfaction that telemedicine has found its place without witnessing commodification. Nearly 45,000 doctors have switched to this practice and 85% of teleconsultations are now between patients and doctors who know each other. It is a guarantee of quality. Regarding their 100% support, if it certainly had to be done during the epidemic period to limit travel, why should we lastingly reimburse teleconsultations better than face-to-face consultations?
The derogatory work stoppages fell into partial unemployment on May 1 and the health insurance bill continues to swell. Where are you ?
It is too early to make a final consolidation of the financial impacts. The bulk of the deficit announced will be due to the collapse of social security revenues. But there were also around 8 billion euros in exceptional spending. This comes from work stoppages related to childcare (just over a billion euros), orders for masks (four billion euros), tests and hospital care at the peak of the crisis . There were also lower expenses in the city because the activity of health professionals was greatly reduced, to the point that we paid aid to 300,000 of them to enable them to meet their expenses.
When will the primary cases reopen?
They never stopped working! In passing, I would like to salute the commitment of all of the 70,000 employees in health insurance who made it possible for our missions to continue during this very complicated period for all. Regarding the receptions, they begin to reopen. Within a fortnight, all cases will offer a welcome, by appointment, with a mask, and we will provide it to policyholders who do not have one.