Les revendications de la FHP pleinement satisfaites ?

Le Journal officielC’est ce qui s’appelle botter en touche, pour ne pas dire plus. En effet, depuis plusieurs mois, la Fédération de l’hospitalisation privée et le syndicat des cliniques spécialisées en chirurgie, médecine, obstétrique, ainsi que d’autres, ont entrepris de mener une lutte juridique et médiatique sans merci contre le ministère de la Santé, s’agissant des tarifs fixés par la rue de Ségur et de l’allocation des crédits MIG (missions d’intérêt général), sans évoquer les AC (aides à la contractualisation), jugés opaques dans leur attribution.

Dans cette lutte médiatique, quelques relais parlementaires sont intervenus. Ainsi, une question parlementaire de la sénatrice Jacqueline Paris posée le 6 mars 2008 a obtenu une réponse il y a quelques jours, publiée au Journal Officiel du 26 novembre dernier ((Sénat, Question n°3645, JO 26 novembre 2009.)).

La question était la suivante :

« Mme Jacqueline Panis attire l’attention de Mme la ministre de la santé, de la jeunesse et des sports sur les préoccupations de la Fédération de l’hospitalisation privée (FHP) relatives à l’augmentation des tarifs hospitaliers fixés pour 2008. Elle constate que leur évolution est inférieure pour la troisième année consécutive au taux d’inflation. Par ailleurs, la FHP soulève le problème des MIGAC (missions d’intérêt général et d’aide à la contractualisation) dont la répartition s’avère inégale entre les deux secteurs hospitaliers. Quant au plan Hôpital 2012, il inquiète la profession craignant que les établissements de santé privés soient exclus du bénéfice des aides à l’investissement. Soucieuse de contribuer à la mise en oeuvre d’une politique de santé conforme aux besoins de la population et aux objectifs fixés par les agences régionales de l’hospitalisation, la FHP souhaite une revalorisation des tarifs suffisante pour couvrir l’évolution des charges et assurer la pérennité des cliniques privées.

En conséquence, elle lui demande de bien vouloir lui indiquer la suite qu’elle entend réserver aux revendications du secteur hospitalier privé. »

Soucieux d’observer la plus stricte économie – de mots – compatible avec les ressources de l’assurance maladie, le ministère de la Santé offre la réponse suivante :

« Chaque année, la ministre de la santé et des sports prend, en application du 1° du I de l’article L. 162-22-11 du code de la sécurité sociale (CSS), un arrêté fixant les tarifs nationaux des prestations mentionnées au 1° de l’article L. 162-22-6 du même code dont les dispositions sont applicables au 1er mars. Cet arrêté doit respecter l’objectif de dépenses des activités de médecine, chirurgie, obstétrique et odontologie (MCO) mentionné au I de l’article L. 162-22-9 du CSS. Pour assurer le respect de cet objectif, la ministre chargée de la santé peut procéder à une régulation infra annuelle des tarifs en application de l’ancienne rédaction du II de l’article L. 162-22-10 du CSS. Constatant, au cours de l’année 2006, une prévision d’activité pour les établissements mentionnés aux d et e de l’article L. 162-22-6 du CSS (cliniques privées) plus importante que celle prise en compte initialement pour fixer les tarifs, il a été décidé, par arrêté en date du 27 septembre 2006, de baisser les tarifs de ces établissements à compter du 1er octobre et jusqu’au 31 décembre 2006, à l’exception des tarifs afférents à certaines activités faisant l’objet de priorités de santé publique (dialyse / HAD) ou dont l’évolution des coûts le justifiait. Par la suite, la Fédération de l’hospitalisation privée, le syndicat des cliniques spécialisées en chirurgie, obstétrique et médecine et autres, ont saisi le Conseil d’État et demandé l’annulation pour excès de pouvoir de cet arrêté du 27 septembre 2006. Dans un arrêt en date du 21 décembre 2007, le Conseil d’État a fait droit à la demande des requérants. Tirant les conséquences de cette annulation, le ministère chargé de la santé a mis en place une procédure de remboursement du différentiel tarifaire en vue de remettre chaque établissement dans la situation dans laquelle il aurait dû se trouver si l’arrêté en cause n’avait pas été pris. À ce jour, la totalité des versements a été réalisée et les attentes des cliniques privées pleinement satisfaites. »
Qu’il nous soit permis un silence dubitatif… Ce qui est dit est aussi important que ce qui n’est pas dit.

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