Réformes du système de santé et devenir du « corps médical »

Résumé Fr En

Le corps médical libéral connaît une division croissante depuis le début des années 1960 : segmentation entre généralistes et spécialistes d’abord, entre spécialités ensuite. L’affermissement de la politique de maîtrise des dépenses, et sa différenciation progressive en fonction des coûts respectifs des spécialités, induisent tout à la fois une concurrence accrue entre segments professionnels, et une incitation à expérimenter de formes nouvelles de coopération entre praticiens.

From 1960, when a national agreement was initially signed, to 1980, when a two-tiered convention was worked out, up till the 1990s, as regulations have been ‘segmented’ by speciality, self-employed medical professionals have been increasingly divided: at first between ‘generalists’ and ‘specialists’ and then into various groups of specialists. This segmentation has sparked further differentiation into professional organizations, itself a sign of a growing competition among segments. It has also broken the traditional political alliance between doctors and successive governments as the drive to control the costs of services has taken off. This segmentation causes problems: intended to serve the patient, it requires more co-ordination in health care. The involvement of certain specialities in evaluation procedures or in health-care networks opens new means for experimenting and co-operating.