PLFSS 2009 ou la bataille des amendements

Véritables lois financières avec de véritables « soldes » financiers, les lois de financement de la Sécurité sociale offrent, depuis la loi organique du 2 août 2005, une grande lisibilité des comptes sociaux au Parlement qui est en mesure de comprendre l’évolution et l’usage de l’Objectif national des dépenses d’assurance maladie (ONDAM). Il n’est pas aisé de fixer les dépenses d’assurance maladie dès lors que, si ces dernières présentent en partie un caractère obligatoire (les assurés sociaux ont droit à une protection), elles sont également marquées par l’aléa, incertitudes liées à des événements extérieurs (croissance faible, pandémie grippale, etc.) ou à des comportements collectifs (abus de prescriptions, évasions fiscales, etc.).

En acquérant une portée indirectement normative, l’ONDAM est devenu l’instrument de la réduction de l’offre de soins.

Pour mémoire, l’ONDAM se calcule sur la base des évolutions de dépenses de l’année précédente et en considération aussi bien des besoins de la population que de la croissance de la richesse nationale. Le but est bien sûr d’éviter que les dépenses ne croissent plus vite que les ressources qui les financent, sans remettre en cause la liberté d’accès aux soins reconnus aux assurés sociaux.

Le calcul de l’ONDAM 2009 n’avait pas initialement prévu la grave crise financière qui est apparue il y a maintenant un peu plus d’un mois et qui est un événement par nature aléatoire et imprévisible.

Or, l’article 47-1 de la Constitution fixe le délai d’examen du PLFSS à 50 jours, ce qui est extrêmement bref. Déposé le 13 octobre dernier, examiné par les députés dès le 28 octobre suivant et voté solennellement par l’Assemblée nationale le 4 novembre dernier (voir ici), le PLFSS 2009 a été rapidement expédié vers les sénateurs.

C’est ainsi que les différentes fédérations de l’hospitalisation, en amont de cet examen, ont –  c’est désormais un rituel – aiguisé leur argumentaire et ont prévu leurs propres amendements.

Dans son argumentaire, la FHF considère que l’hôpital public est le garant de la qualité des soins en France, auquel les Français sont très attachés. Loin d’être un monolithe incapable de se réformer et d’innover, cette structure publique sait s’adapter pour une meilleure efficience (contraction des termes efficacité et science ?). Or, le service public de la santé est aujourd’hui menacé par l’asphyxie budgétaire, par la fragilisation de l’égalité d’accès aux soins et la convergence des tarifs public/privé sans tenir compte des activités propres au secteur public telles que la prise en charge de la précarité, insusceptible d’être mesurée actuellement par la tarification à l’activité.

Parce que les hôpitaux ont vocation à soigner tout le monde sans distinction. Parce que leurs missions d’intérêt général sont insuffisamment financées. Parce que les hôpitaux publics engagent des dépenses dont les cliniques peuvent se dispenser. Parce que les hôpitaux publics gèrent du personnel au statut très protecteur et sur lequel ils n’ont pas de prise. Pour toutes ces raisons, la FHF souhaite plus de moyens à disposition des hôpitaux pour défendre leur image d’excellence et assurer l’égalité d’accès aux soins de tous les citoyens.

A cette fin, elle a préparé un panel d’amendements.

Dans son argumentaire, la FHP dresse le constat de ce que l’hospitalisation privée prend en charge et soigne 7 millions de personnes par an, détenant ainsi une place essentielle dans l’offre de soins. Les cliniques emploient les deniers publics à bon escient, qualité attestée, selon la FHP par l’Inspection Générale des Affaires Sociales, par l’Assurance maladie, et par l’Agence Technique d’Information sur l’Hospitalisation, cependant que les hôpitaux publics sont empêtrés dans une culture du déficit et gèrent des charges de personnel écrasantes pour un absentéisme chronique.

La qualité des soins dispensés dans les établissements privés lucratifs est reconnue par l’ancienne Agence Nationale d’Accréditation des Etablissements de Santé (ANAES), devenue Haute Autorité de Santé (HAS).

La FHP explique enfin que la convergence tarifaire est un impératif vital et possible, en ce qu’elle est inscrite dans la loi, parce qu’il s’agit d’une question d’équité et d’un impératif économique pour l’Assurance maladie.

Proposition audacieuse, ce syndicat propose, à titre expérimental, de confier par contrat la gestion d’établissements publics en situation de déficit chronique, à des opérateurs privés.

Ses propositions d’amendements peuvent être consultées ici.

En l’absence d’argumentaire, la FEHAP, de son côté, a focalisé ses propositions d’amendements sur des points précis, tels que la fixation des tarifs plafonds pour les unités de soins de longue durée, la valorisation de l’activité de consultations externes des praticiens salariés, le reversement par les établissements d’hébergement des personnes âgées dépendantes des sommes indues dans le cadre des forfaits de soins, etc.

Il reste peu de temps maintenant pour que ces différents syndicats pèsent de tout leur poids dans les discussions devant le Sénat afin de faire valoir leurs arguments où se mêlent à la fois études sérieuses et fiables, mauvaise foi et tactique politique. C’est le jeu de la démocratie.

Omar YAHIA

This Post Has 297 Comments

  1. Just came from google to your website have to say thanks.

  2. taxi soelden dit :

    the time to study or check out the content or sites we’ve linked to below the

  3. CBN wheels dit :

    Here is a good Blog You may Find Interesting that we Encourage You

  4. refuse sales dit :

    Excellent items from you, man. I’ve be aware your
    stuff prior to and you’re simply too fantastic. I actually
    like what you have got right here, certainly like what you’re
    saying and the way through which you say it. You make it enjoyable and you
    continue to care for to stay it smart. I can not wait to read much more
    from you. That is actually a great website.

  5. Howdy! Do you use Twitter? I’d like to follow you if that would be okay.
    I’m undoubtedly enjoying your blog and look forward to new updates.

  6. one of our visitors lately encouraged the following website

  7. kegel ball dit :

    although websites we backlink to below are considerably not related to ours, we feel they are in fact really worth a go through, so possess a look

  8. here are some hyperlinks to sites that we link to simply because we consider they may be worth visiting

  9. You have made some decent points there. I checked on the internet for additional information about the issue and found most
    individuals will go along with your views on this website.

  10. please check out the web sites we adhere to, such as this one, because it represents our picks from the web

  11. that is the end of this write-up. Here youll uncover some web sites that we think you will appreciate, just click the links over

  12. I more or less share your take on this topic and look forward to additional posts and comments here at hospidroit.net. Thanks!

  13. Quality articles or reviews is the key to interest the users to visit the web site, that’s what this
    website is providing.

  14. Jada dit :

    What i do not realize is actually how you’re now not really
    much more well-favored than you may be now. You’re very intelligent.

    You understand therefore significantly on the subject of this topic, produced me in my opinion believe it from a lot of varied angles.
    Its like women and men are not fascinated except it is one thing to accomplish with Woman gaga!
    Your personal stuffs nice. At all times deal with
    it up!

  15. Link exchange is nothing else however it is simply placing
    the other person’s weblog link on your page at proper place and other person will also do similar in support of you.

  16. Enid dit :

    My brother suggested I would possibly like this blog.

    He used to be entirely right. This post actually
    made my day. You can not believe just how so much time I had spent for this
    information! Thanks!

  17. link dit :

    A colleague in the field told me to check out your website.

  18. Johnie dit :

    After I originally commented I seem to have clicked the -Notify me when new comments are added- checkbox and now whenever a comment is added
    I recieve 4 emails with the exact same comment.

    Perhaps there is a means you can remove me from
    that service? Many thanks!

  19. Why visitors still use to read news papers when in this technological
    globe the whole thing is existing on web?

  20. Here is a superb Blog You may Obtain Fascinating that we Encourage You

  21. Greetings! Very helpful advice within this article! It is the
    little changes that produce the most significant changes.
    Thanks a lot for sharing!

  22. Here are a number of the internet sites we recommend for our visitors

  23. Hi, I do believe this is a great website. I stumbledupon it 😉 I’m going to revisit yet again since i have saved as a
    favorite it. Money and freedom is the best way to change, may you be rich and continue to guide other people.

  24. When I initially commented I clicked the « Notify me when new comments are added » checkbox and
    now each time a comment is added I get four emails with the same comment.
    Is there any way you can remove people from that service?
    Cheers!

  25. Chandra dit :

    that is the end of this post. Right here youll uncover some internet sites that we consider youll value, just click the links over

  26. Asking questions are actually pleasant thing if you are not understanding anything fully,
    except this piece of writing gives good understanding even.

  27. It’s wonderful that you are getting ideas from this post as
    well as from our dialogue made at this place.

  28. Randell dit :

    Can you tell us more about this? I’d love to find
    out some additional information.

  29. It is perfect time to make some plans for the future and it is time to
    be happy. I’ve read this post and if I could I want
    to suggest you few interesting things or tips.

    Maybe you could write next articles referring to this article.
    I want to read more things about it!

  30. Hi! I could have sworn I’ve been to this website before but
    after reading through some of the post I realized
    it’s new to me. Anyways, I’m definitely happy I found it and I’ll be bookmarking and checking back frequently!

  31. Bobby dit :

    I am really impressed with your writing skills
    as well as with the layout on your weblog.
    Is this a paid theme or did you customize it yourself?
    Either way keep up the excellent quality
    writing, it’s rare to see a nice blog like this one these days.

  32. webcam models dit :

    just beneath, are numerous entirely not related sites to ours, having said that, they may be certainly really worth going over

  33. Hey I know this is off topic but I was wondering if you knew of any widgets I
    could add to my blog that automatically tweet my newest twitter updates.
    I’ve been looking for a plug-in like this for quite some time
    and was hoping maybe you would have some experience with something
    like this. Please let me know if you run into anything.

    I truly enjoy reading your blog and I look forward to your new updates.

  34. usually posts some incredibly intriguing stuff like this. If youre new to this site

  35. Wonderful story, reckoned we could combine some unrelated information, nonetheless actually really worth taking a look, whoa did one master about Mid East has got extra problerms at the same time

  36. I’m really impressed with your writing skills and also with the layout on your blog.
    Is this a paid theme or did you modify it yourself? Anyway keep up the nice quality
    writing, it’s rare to see a great blog like this one nowadays.

  37. The facts mentioned within the post are a few of the most effective obtainable

  38. Sites of interest we’ve a link to

  39. Gary dit :

    I think the admin of this web page is actually working hard in favor of his site, because here every information is quality
    based stuff.

  40. one of our guests just lately proposed the following website

  41. the time to study or pay a visit to the subject material or sites we have linked to beneath the

  42. Link exchange is nothing else except it is just placing the other
    person’s webpage link on your page at proper place and other person will also do same in favor
    of you.

  43. Here are a number of the internet sites we recommend for our visitors

  44. Melva dit :

    I got this web page from my buddy who informed me about this web page
    and at the moment this time I am visiting this website and reading
    very informative articles or reviews at this place.

  45. Here is a superb Blog You may Find Exciting that we Encourage You

  46. although web-sites we backlink to below are considerably not related to ours, we feel they may be in fact worth a go via, so possess a look

  47. just beneath, are several entirely not connected web sites to ours, nonetheless, they may be surely really worth going over

  48. Please let me know if you’re looking for a writer for your weblog.
    You have some really great posts and I feel I would be a good asset.
    If you ever want to take some of the load off, I’d really like to write some material for your blog in exchange for
    a link back to mine. Please blast me an e-mail if interested.
    Many thanks!

  49. check beneath, are some entirely unrelated internet sites to ours, having said that, they may be most trustworthy sources that we use

  50. Woxe Nitamo dit :

    Thanks for your patience and sorry for the inconvenience!

  51. I don’t know whether it’s just me or if perhaps everybody else experiencing problems with your
    blog. It seems like some of the written text within your content are running off the screen. Can someone else please comment and let me know if this is happening to them too?
    This may be a problem with my internet browser because I’ve had this happen before.
    Thank you

  52. very handful of web sites that transpire to become detailed below, from our point of view are undoubtedly nicely worth checking out

  53. we came across a cool web-site that you just might get pleasure from. Take a search should you want

  54. the time to study or pay a visit to the subject material or websites we’ve linked to below the

  55. Lena dit :

    I’ve been exploring for a little for any high-quality
    articles or weblog posts on this kind of space .
    Exploring in Yahoo I at last stumbled upon this site.

    Reading this info So i’m glad to show that I have a very just right uncanny feeling I came upon exactly what I needed.
    I such a lot without a doubt will make sure to do not omit this site and provides it a look on a relentless basis.

  56. that may be the end of this post. Right here youll find some websites that we consider youll enjoy, just click the hyperlinks over

  57. Louie dit :

    great issues altogether, you simply won a logo new reader. What would you recommend about your put up that you made a few days ago? Any positive?

  58. just beneath, are several completely not related web sites to ours, nevertheless, they’re certainly really worth going over

  59. we came across a cool website that you might get pleasure from. Take a look if you want

  60. Lan dit :

    My brother recommended I might like this website. He was totally right. This post actually made my day. You can not imagine simply how much time I had spent for this info! Thanks!

  61. The info mentioned inside the article are several of the very best accessible

  62. Superb site you have here but I was curious about if you knew
    of any user discussion forums that cover the same topics talked about
    here? I’d really love to be a part of community where I can get comments
    from other knowledgeable individuals that share the same interest.
    If you have any suggestions, please let me know. Thanks
    a lot!

  63. credit based dit :

    I am regular reader, how are you everybody? This paragraph posted at this web page is really
    nice.

  64. transportista dit :

    Busca Concesionarios especializados en la Compra y Venta de Camiones y Trileres, Camiones usados o nuevos de todas los aos, marcas y modelos. Hgalo Aqu

  65. Howdy! This is kind of off topic but I need some advice from an established blog.
    Is it very hard to set up your own blog? I’m not
    very techincal but I can figure things out pretty quick.

    I’m thinking about creating my own but I’m not sure where to start.
    Do you have any points or suggestions? Thanks

  66. very handful of web-sites that transpire to become comprehensive below, from our point of view are undoubtedly well really worth checking out

  67. that would be the finish of this post. Right here you will come across some websites that we believe you will value, just click the links over

  68. always a major fan of linking to bloggers that I like but do not get a great deal of link love from

  69. very couple of internet sites that transpire to become in depth below, from our point of view are undoubtedly well worth checking out

  70. Here are several of the sites we suggest for our visitors

  71. always a large fan of linking to bloggers that I appreciate but really don’t get lots of link enjoy from

  72. Here is a superb Blog You might Obtain Fascinating that we Encourage You

  73. ohrayos dit :

    Every as soon as in a although we choose blogs that we study. Listed below would be the newest internet sites that we pick

  74. below youll discover the link to some sites that we feel you ought to visit

  75. below you will come across the link to some internet sites that we assume you need to visit

  76. please pay a visit to the sites we stick to, which includes this 1, because it represents our picks from the web

  77. black gold dit :

    that may be the end of this article. Here youll find some sites that we consider you will appreciate, just click the links over

  78. that would be the finish of this write-up. Here you will come across some web-sites that we feel you will appreciate, just click the links over

  79. best coffee dit :

    Every as soon as inside a even though we decide on blogs that we read. Listed beneath are the most up-to-date web sites that we pick out

  80. check below, are some totally unrelated websites to ours, having said that, they are most trustworthy sources that we use

  81. Wonderful story, reckoned we could combine several unrelated data, nonetheless actually really worth taking a look, whoa did a single find out about Mid East has got additional problerms too

  82. Jesse dit :

    I’m impressed, I must say. Rarely do I encounter a blog that’s both educative and amusing, and let me
    tell you, you’ve hit the nail on the head. The problem is something which too
    few men and women are speaking intelligently about. I’m very happy that I found this during
    my search for something concerning this.

  83. although internet sites we backlink to below are considerably not connected to ours, we really feel they are basically really worth a go via, so have a look

  84. Here are several of the websites we suggest for our visitors

  85. you’re in reality a good webmaster. The site loading velocity is amazing.
    It seems that you’re doing any unique trick. Furthermore,
    The contents are masterwork. you have performed a fantastic job in this subject!

  86. Here is a great Blog You might Find Fascinating that we Encourage You

  87. check below, are some entirely unrelated websites to ours, however, they are most trustworthy sources that we use

  88. Tonia dit :

    Thanks for ones marvelous posting! I really enjoyed reading it, you happen to be a great author.I will make certain to bookmark your blog and definitely
    will come back in the foreseeable future. I want to encourage you to ultimately continue your great job,
    have a nice morning!

  89. Hai Bulinski dit :

    1/2/2017 I’m gratified with the way that hospidroit.net deals with this kind of subject matter! Generally to the point, sometimes controversial, without fail thoughtful as well as thought-provoking.

  90. just beneath, are several completely not related web pages to ours, however, they’re surely really worth going over

  91. Whoa! This blog looks exactly like my old one!
    It’s on a entirely different subject but it has pretty much the same
    page layout and design. Outstanding choice of colors!

  92. It’s remarkable in favor of me to have a web site, which is useful in favor of my
    experience. thanks admin

  93. Wonderful story, reckoned we could combine a number of unrelated data, nonetheless actually really worth taking a appear, whoa did one learn about Mid East has got additional problerms too

  94. Every as soon as inside a although we pick blogs that we study. Listed beneath are the most current web pages that we pick out

  95. Chauncey dit :

    It’s an remarkable paragraph for all the web visitors;
    they will take advantage from it I am sure.

  96. Angelina dit :

    Do you have a spam issue on this site; I also am a
    blogger, and I was curious about your situation;
    many of us have created some nice procedures and we are looking to trade solutions with others,
    be sure to shoot me an e-mail if interested.

Leave A Reply