“There are patients who can reoffend”: concern about a potential reform of long -term condition

If the idea is not new, it today has the favors of the government: Yannick Neuder, Minister of Health, said on LCP that a patient who comes under the ALD device and which would be “in complete remission” should see its “suspended” affiliation. In addition, Aim of the operation: to reduce the deficit of health insurance. For example, estimated at 16 billion euros this year, but which could rise to 41 billion in 2035. Moreover, And this. In addition, while the ALD device already represents two thirds of the annual expenses of the CPAM and could represent three quarters by 2035.

2 What would it change? – "there patients who can reoffend":

Being taken care of under long -term condition is to see your health expenses covered at 100 % of the ceiling set by Social Security for your pathology (cancer. Consequently, cardiovascular disease, diabetes, Alzheimer, etc.). “there patients who can reoffend”: This status is not granted for life to the patient, but is reassessed every five years. Different management configurations are possible. whether you are considered in ALD or at the end of the device, with a possibility of returning to the system in the event of a recurrence or appearance of serious late sequelae.

The health insurance project intends to keep this possibility of returning to the system in the presence of a relapse. But it aims to graduate more the care of care. by leaving the patient more quickly from the 100 % reimbursed system if he is considered to be cured, in remission or if he has no more visible handicap linked to his affection.

In addition to this measure. health insurance would like to delay the entry of patients into the ALD system by creating an “chronic risk” status and define “a list of specific and opposable care” “there patients who can reoffend”: offering the right to a total reimbursement for each long pathology.

3 What do doctors think?

They are very vigilant on the project. recalling that even with an ALD, patients already find themselves paying from their pocket a certain number of costs linked to their pathology (excess of fees, franchises …). Catherine Simonin. a member of the Cancer League, indicates that a suspension in the event of healing or remission could study when, for example, after “a diagnosis of cancer, there is surgery and there is no treatment behind”. “If there is just a need to follow up on a consultation per year to see them. yes, it can be discussed. »»

For the rest. a “definition of complete remission is purely theoretical and arbitrary”, recalls Professor Olivier Cussenot, of the National Association of Prostate Cancer patients. “There are patients who, even after 20 years of remission, can reoffend.” “People who are “there patients who can reoffend”: in remission often have treatments. medications: for breast cancer, there is hormone therapy which is given at least for five years”, illustrates René Ducroux, president of Atoutcancer.

The Gustave-Roussy cancer fighting center recalls that 63.5 % of people. however, healed from cancer suffer from “heavy consequences” which “degraded their quality of life in the long term”, between “pain, fatigue, chronic disorders of motor, urinary and gastric disorders”.

An excessive exit of the ALD would also be detrimental to psychological support. “People who have had cancer are afraid of recurrence and need follow -up,” rebounds René Ducroux. Olivier Cussen abounds: “The problem of prostate cancer is an impact on quality of life. with possible disorders of erectile function or urinary incontinence”.