Activité libérale à l’hôpital : suite du feuilleton jurisprudentiel

Photo personnelle - argentLa question de la détermination de l’assiette des redevances dont les praticiens hospitaliers à temps plein doivent s’acquitter au titre de leur activité libérale a récemment donné lieu à une nouvelle décision du Conseil d’Etat ((CE, 29 mai 2009, Syndicat national de chirurgie plastique, reconstructrice et esthétique et autres, n°318071 et Syndicat national de défense de l’exercice libéral de la médecine à l’hôpital, n°322288.)), lequel avalise la solution retenue par les pouvoirs publics. Rappelons le contexte.

Le 7 mars 2006, un premier décret a établi les modalités de calcul des redevances dues par les PH exerçant une activité libérale à l’établissement dans lequel ils évoluent. Le dispositif a été contesté devant le juge et le Conseil d’Etat a mis fin à la règle selon laquelle son montant devait être plafonné par le coût de la prestation fournie par le service et a validé l’instauration d’une tarification en fonction des honoraires perçus ((CE, Ass., 16 juillet 2007, Syndicat national de défense de l’exercice libéral de la médecine à l’hôpital, Syndicat national de chirurgie plastique, reconstructrice et esthétique, AJDA 2007. 1807, chron. J. Boucher et B. Bourgeois-Machureau.)).

Nous nous en étions ouverts ici.

Dans la même décision, le Conseil d’Etat a rappelé que « le tarif doit être établi selon des critères objectifs et rationnels, dans le respect du principe d’égalité et des règles de concurrence », ce qui l’a conduit à censurer, au nom du principe d’égalité, la différence d’assiette de la redevance établie dans le décret, lequel opérait une distinction selon que les actes accomplis sont ou non remboursés par la sécurité sociale.

Les pouvoirs publics ont naturellement tiré les conséquences du sens de la décision en modifiant le mode de calcul de la redevance par deux décrets (n°2008-464 du 15 mai 2008 et n°2008-1060 du 14 octobre 2008) : peu importe que les actes soient ou non remboursés par la sécurité sociale, le calcul étant désormais fonction des honoraires effectivement perçus par les praticiens concernés.

Ces deux textes ont fait l’objet d’un recours contentieux devant le Conseil d’Etat qui s’est prononcé à ce sujet par décision du 29 mai 2009. Les nouvelles bases de calcul de la redevance établies dans les textes attaqués sont, estime-t-il, légales.

Exerçant un contrôle restreint sur la détermination du taux des redevances, le juge administratif considère que les taux retenus dans les décrets attaqués ne sont pas manifestement disproportionnés au regard de la valeur du service rendu aux praticiens par les établissements de santé.

S’il existe évidemment des différences de pourcentage entre les CHR faisant partie d’un CHU et les autres établissements publics de santé, cette différence, qui n’excède pas 20%, n’est pas manifestement disproportionnée, au regard notamment des coûts de structures (liées aux installations techniques, aux locaux ou encore aux personnels) qui existent entre ces catégories d’établissements.

Au plan pratique, l’administration hospitalière éprouvera sans doute quelque difficulté à percevoir l’intégralité de ce qui lui est dû, dans la mesure où la connaissance des montants des honoraires effectivement perçus s’avère délicate. Il faudrait que les PH délivrent consciencieusement les informations sur leur activité libérale chaque trimestre à la commission de l’activité libérale rattachée à la commission médicale d’établissement, laquelle doit en principe, selon les textes, établir un rapport annuel, qui sera ensuite présenté notamment devant le conseil d’administration de l’établissement (ou selon la taille de l’établissement : conseil de surveillance/directoire).

A lire les rapports d’observations définitives des Chambres régionales des comptes, il semble que ces obligations réglementaires ne soient pas scrupuleusement respectées, loin de là.

This Post Has 1 885 Comments

  1. Muk Pokemon dit :

    You need to participate in a contest for the most effective blogs on the web. I’ll suggest this site!

  2. new business dit :

    I truly appreciate this post. I ave been looking everywhere for this! Thank God I found it on Bing. You ave made my day! Thanks again..

  3. very handful of internet sites that transpire to be detailed beneath, from our point of view are undoubtedly nicely worth checking out

  4. Colin Ogden dit :

    At this time I am going to do my breakfast, after having my breakfast coming yet again to read further news.

  5. Nicholas Carr dit :

    Excellent blog here! Also your web site quite a bit up very fast! What host are you using? Can I am getting your affiliate link for your host? I want my web site loaded up as quickly as yours lol

  6. Really informative article.Much thanks again.

  7. If you are free to watch comical videos on the internet then I suggest you to pay a quick visit this web site, it contains actually therefore humorous not only videos but also extra information.

  8. Usually I do not read article on blogs, but I wish to say that this write-up very pressured me to take a look at and do it! Your writing style has been surprised me. Thanks, very great article.

  9. I do trust all of the ideas you’ve presented on your post.
    They’re very convincing and can certainly work.
    Nonetheless, the posts are very short for beginners.
    May just you please lengthen them a bit from subsequent time?

    Thanks for the post.

  10. This is a list of words, not an essay. you will be incompetent

  11. Hello, you used to write excellent, but the last few posts have been kinda boring… I miss your great writings. Past few posts are just a little bit out of track! come on!

  12. qqtube review dit :

    Whats up! I simply wish to give a huge thumbs up for the nice information you may have here on this post. I will be coming back to your blog for extra soon.

  13. I’m very happy to read this. This is the kind of manual that needs to be given and not the random misinformation that is at the other blogs. Appreciate your sharing this best doc.

  14. I’m extremely impressed with your writing skills and also with the layout on your blog. Is this a paid theme or did you customize it yourself? Either way keep up the excellent quality writing, it is rare to see a nice blog like this one these days..

  15. You need to take part in a contest for one of the best sites
    on the web. I will recommend this website!

  16. poliform dit :

    spelling issues and I to find it very troublesome to tell the truth however I will definitely come back again.

  17. It’s in point of fact a great and useful piece of info. I’m glad that you just shared this helpful information with us. Please keep us up to date like this. Thank you for sharing.

  18. we like to honor numerous other online internet sites on the internet, even when they arent linked to us, by linking to them. Under are some webpages worth checking out

  19. Porno video dit :

    Does your site have a contact page? I’m having a tough time locating it but, I’d like to shoot you an email. I’ve got some creative ideas for your blog you might be interested in hearing. Either way, great site and I look forward to seeing it improve over time.|

  20. sex video dit :

    What’s up everyone, it’s my first go to see at this website, and post is actually fruitful in support of me, keep up posting these content.|

  21. Wow that was unusual. I just wrote an very long comment but after I clicked submit my comment didn at show up. Grrrr well I am not writing all that over again. Anyway, just wanted to say great blog!

  22. try here dit :

    Wow, wonderful blog layout! How long have you been blogging for? you make blogging look easy. The overall look of your web site is magnificent, as well as the content!

  23. I think this internet site holds some very great info for everyone .

  24. Una Hemmings dit :

    It’s a pity you don’t have a donate button! I’d definitely donate to this excellent blog! I guess for now i’ll settle for bookmarking and adding your RSS feed to my Google account. I look forward to brand new updates and will talk about this website with my Facebook group. Chat soon!

  25. Julia Short dit :

    Hi, i feel that i saw you visited my site thus i came to « return the want ».I am attempting to to find issues to improve my website!I guess its ok to use some of your concepts!!

  26. This web site truly has all the info I needed about this subject and didn at know who to ask.

  27. make money dit :

    Thanks a lot for the blog article.Much thanks again. Awesome.

  28. This is my first time pay a visit at here and i am really impressed to read all at alone place.

  29. I think this is a real great article post.Really looking forward to read more. Will read on

  30. Porfirio dit :

    If you want to get a great deal from this piece of writing then you
    have to apply these techniques to your won website.

  31. Mauritius dit :

    There is certainly noticeably a bundle to know about this. I assume you produced specific nice points in attributes also.

  32. Thomas Quinn dit :

    Good looks, excellent picture quality, and Simply SMART. What would have been the best possible outcome in a situation like this’. How I use it As a travel blogger, I use the Action Cam to document my experiences, both via photos and video.

  33. home decor dit :

    Incredible! This blog looks just like my old one! It as on a completely different subject but it has pretty much the same page layout and design. Great choice of colors!

  34. Connor Short dit :

    Way cool! Some extremely valid points! I appreciate you writing this post plus the rest of the site is also really good.

  35. Hi there! I know this is kind of off topic but I was wondering which blog platform are you using for this website? I’m getting tired of WordPress because I’ve had problems with hackers and I’m looking at options for another platform. I would be awesome if you could point me in the direction of a good platform.|

  36. 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 me from that service? Bless you!|

  37. I am so grateful for your article.Thanks Again. Great.

  38. click here dit :

    Hey, thanks for the blog post.Thanks Again. Keep writing.

  39. I really like and appreciate your blog post.Really thank you! Really Cool.

  40. You completed approximately first degree points there. I searched by the internet for the problem and found most individuals will chance collected with down with your website.

  41. Rafting bosna dit :

    Really enjoyed this article.Really thank you! Great.

  42. please go to the internet sites we follow, such as this one particular, as it represents our picks through the web

  43. Amado dit :

    Thank you for the auspicious writeup. It actually used to be a enjoyment account it.
    Look complex to more introduced agreeable
    from you! By the way, how could we be in contact?

  44. apps for pc dit :

    Wonderful story, reckoned we could combine several unrelated data, nevertheless truly really worth taking a search, whoa did 1 discover about Mid East has got far more problerms also

  45. Major thankies for the article post. Really Cool.

  46. This is a topic that’s near to my heart… Take care! Exactly where are your contact details though?|

  47. Thank you ever so for you post.Much thanks again. Fantastic.

  48. themevps dit :

    Really informative blog.Thanks Again. Much obliged.

  49. I retired early will right away snatch your rss as I retired early can’t to find your e-mail subscription link or newsletter service. Do you have any? Please allow me recognize in order that I retired early could subscribe. Thanks.

  50. Today, I went to the beach with my children. I found a sea shell and gave it to my 4 year old daughter and said « You can hear the ocean if you put this to your ear. » She placed the shell to her ear and screamed.
    There was a hermit crab inside and it pinched her ear.
    She never wants to go back! LoL I know this is totally off topic but I had to tell someone!

  51. I could not resist commenting. Well written!|

  52. outdoor movie dit :

    It as laborious to search out knowledgeable folks on this matter, but you sound like you comprehend what you are speaking about! Thanks

  53. Pokemon Go Players have been browsing online more than three hours today, yet Pokemon Go Players never found any interesting article like yours. It’s pretty worth enough for me. In my opinion, if all site owners and bloggers made good content as you did, the web will be much more useful than ever before.

  54. Adderall dit :

    Way cool! Some very valid points! I appreciate you penning this write-up and the rest of the site is also really good.

  55. click here dit :

    It was truly informative. Your website is very useful.

  56. Awesome read. I just passed this onto a friend who was doing some research on that. He actually bought me lunch because I found it for him! So let me rephrase: Thanks for lunch!

  57. read more dit :

    I am so grateful for your article post.Thanks Again. Fantastic.

  58. Really enjoyed this article post.Thanks Again. Really Cool.

  59. I am glad to be one of the visitors on this outstanding site (:, appreciate it for putting up.

  60. view more dit :

    Thanks a lot for the article post. Fantastic.

  61. click here dit :

    Great, thanks for sharing this blog post.Thanks Again. Awesome.

  62. 2018 BMW i8 dit :

    This is a great web page, might you be interested in doing an interview about just how you created it? If so e-mail me!

  63. one of our guests not long ago suggested the following website

  64. click here dit :

    I think this is a real great blog article.Thanks Again. Much obliged.

  65. Quality posts is the key to attract the people to pay a
    visit the website, that’s what this site is providing.

  66. usuwanie dpf dit :

    usuwanie dpf

    […]Sites of interest we’ve a link to[…]

  67. I really liked your article.Really thank you! Great.

  68. Hey, thanks for the article.Really looking forward to read more.

  69. Chloe Edmunds dit :

    Exceptional post however I was wanting to know if you could write a litte more on this subject? I’d be very thankful if you could elaborate a little bit more. Thank you!

  70. You’ve got some really interesting info here, well written and your website is
    user-friendly.

  71. click here dit :

    Say, you got a nice blog post.Really looking forward to read more. Really Cool.

  72. First of all I would like to say terrific blog! I had a
    quick question in which I’d like to ask if you don’t mind.
    I was curious to know how you center yourself and clear your thoughts before writing.

    I’ve had trouble clearing my mind in getting my ideas out.
    I truly do take pleasure in writing but it just seems like the first 10 to 15 minutes are lost just trying to figure
    out how to begin. Any recommendations or tips? Kudos!

  73. You are a very capable person!

  74. I am so grateful for your blog post.Much thanks again. Really Great.

  75. Excellent goods from you, man. I have keep in mind your stuff prior to and
    you’re simply too excellent. I really like what you’ve bought right here, certainly like what you’re stating and the way in which in which you
    assert it. You are making it entertaining and you continue to
    take care of to stay it smart. I cant wait to
    read far more from you. That is actually a tremendous web
    site.

  76. I think this is a real great article post.Really thank you! Awesome.

  77. Theresa Gray dit :

    Hey there I am so happy I found your website, I really found you by error, while I was browsing on Askjeeve forr something else, Anyhow I am here now and would just like to say thanks a lot for a incredible post and a all round enjoyable blog (I akso love the theme/design), I don’t have timme tto read it all at the moment but I have book-marked it aand also added in your RSS feeds, so when I have time I will be back to read a great deal more, Please do keep up thee awesome b.

  78. wow, awesome blog article.Much thanks again. Awesome.

  79. Simon King dit :

    fantastic points altogether, you just won a logo new reader. What could you suggest about your post that you just made a few days ago? Any certain?

  80. Great goods from you, man. I’ve understand your stuff previous to and
    you’re just too excellent. I actually like what you’ve acquired
    here, really like what you’re saying and the way in which you say it.
    You make it entertaining and you still take care of to keep it wise.
    I cant wait to read far more from you. This is actually a wonderful
    site.

  81. Curt dit :

    When I originally commented I appear to have clicked the -Notify me when new comments are added- checkbox and from now
    on whenever a comment is added I receive four emails with the exact
    same comment. Perhaps there is a means you are able to remove me from that service?
    Cheers!

  82. If you wish for to increase your knowledge only keep visiting
    this website and be updated with the most recent information posted here.

  83. talk money dit :

    I like the helpful information you provide on your articles.
    I’ll bookmark your weblog and take a look at once more here regularly.
    I’m rather sure I will be informed many new stuff right right here!
    Good luck for the following!

  84. Babydoll dit :

    Babydoll

    […]Wonderful story, reckoned we could combine some unrelated data, nonetheless seriously worth taking a look, whoa did one master about Mid East has got a lot more problerms also […]

  85. Thank you ever so for you blog post. Cool.

Leave A Reply