Ecarts tarifaires public/privé : l’exemple de l’IVG

Photo personnelle - Finances hospitalièresLa lecture quotidienne du Journal Officiel (JO) me semble être un excellent exercice pour qui souhaite s’informer des évolutions législatives et réglementaires « au fil de l’eau », laquelle permet pour le regard aguerri de s’apercevoir – est-il encore besoin de le rappeler sans verser dans le passéisme ? – de la qualité déclinante des textes caractérisée par la rédaction parfois confuse, parfois (volontairement ?) ambiguë, s’illustrant souvent par un mal endémique : la technique du renvoi. Un texte A renvoie en effet à un texte B qui lui-même renvoie à un texte C, de sorte que le lecteur chevronné devra s’armer de patience et de différents codes pour saisir la profondeur du sens que le législateur aura bien voulu donner au texte examiné.

La lecture de ce matin m’a donné l’occasion, à partir d’un simple arrêté, de me pencher, avec distance il est vrai, sur une question qui déchire l’hospitalisation publique et privée : les écarts tarifaires. Une polémique est née en effet de la décision de la ministre de la Santé de reporter à 2018 la convergence tarifaire public/privé, initialement prévue pour 2012 aux termes de la loi de 2004 sur l’Assurance maladie.

Si elle s’est félicitée dans un premier temps de cette décision, la Fédération de l’hospitalisation de France (FHF) avoue quelque impatience devant l’inertie des services du ministère face à cette délicate question de la convergence intersectorielle.

Cela étant dit, revenons toutefois au texte qui m’a poussé à m’interroger sur cette problématique.

Publié au JO il y a deux jours, il s’agit de l’arrêté du 4 août 2009 modifiant l’arrêté du 23 juillet 2004 relatif aux forfaits afférents à l’interruption volontaire de grossesse.

Revenons au texte initial : l’arrêté du 23 juillet 2004. Ce texte réglementaire a été modifié par arrêté du 4 avril 2008, pour en venir enfin à l’arrêté du 4 août, loin de résonner comme une abolition des privilèges.

Il n’est point besoin d’être un économiste de la santé pour constater au fil de l’évolution de l’arrêté de 2004 que les tarifs ont augmenté. En fait de santé, les prix diminuent rarement, à la vérité.

Plus encore, on remarquera également que les tarifs ne sont pas exactement identiques entre les prestations assurées dans les établissements mentionnés au d (traduisez « cliniques privées à but lucratif ») de l’article L.162-22-6 du code de la sécurité sociale, d’une part, et les établissements mentionnés au a, b et c du même article (traduisez établissements de santé publics et établissements de santé privés à but non lucratif, pour faire simple), d’autre part.

Contre l’hostocomparateur mis en place par la Fédération de l’hospitalisation privée (FHP), la FHF – qui ne nie pas l’existence des écarts tarifaires – a rétorqué par son propre argumentaire, au sujet duquel je laisse aux commentateurs le soin de donner leur sentiment, s’ils le souhaitent.

Au-delà du particularisme d’un texte réglementaire donné, le Journal Officiel a ceci de vertueux qu’il invite parfois à une réflexion plus générale.

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