{"id":15626,"date":"2013-12-01T00:00:00","date_gmt":"2013-11-30T23:00:00","guid":{"rendered":"http:\/\/ricom-web.com\/gestions-hospitalieres\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/"},"modified":"2018-03-07T17:22:34","modified_gmt":"2018-03-07T16:22:34","slug":"qualite-du-systeme-de-sante-et-maitrise-des-depenses","status":"publish","type":"post","link":"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/","title":{"rendered":"Qualit\u00e9 du syst\u00e8me de sant\u00e9 et ma\u00eetrise des d\u00e9penses"},"content":{"rendered":"<span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 4<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span><h1 class=\"para-TC_inter_01\"><span class=\"char-of-TC_inter_01-29\"><img decoding=\"async\" class=\"wp-image-27407 alignleft\" src=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2016\/10\/ill_2013_612_01-215x300.png\" alt=\"ill_2013_612_01\" width=\"150\" height=\"209\" srcset=\"https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/10\/ill_2013_612_01-215x300.png 215w, https:\/\/www.ricom-web8.com\/gestions\/wp-content\/uploads\/2016\/10\/ill_2013_612_01.png 600w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/>Contexte et enjeux\u00a0<\/span><\/h1>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">L\u2019objectif national des d\u00e9penses d\u2019assurance maladie (Ondam) a atteint 170 milliards d\u2019euros en 2012 et augmente tendanciellement de 4 % par an, soit pr\u00e8s de 7 milliards d\u2019euros. Malgr\u00e9 tout, la croissance du produit int\u00e9rieur brut (PIB) \u2013 proche de 1 % \u2013 et donc des recettes de l\u2019Assurance Maladie est structurellement insuffisante pour soutenir une augmentation tendancielle aussi importante. Dans leur rapport \u00ab Propositions pour la ma\u00eetrise de l\u2019Ondam \u00bb de juin 2012, l\u2019Inspection g\u00e9n\u00e9rale des affaires sociales (Igas) et l\u2019Inspection g\u00e9n\u00e9rale des finances (IGF) ont ainsi chiffr\u00e9 \u00e0 plus de 2 milliards d\u2019euros par an les efforts \u00e0 fournir sur les cinq ann\u00e9es \u00e0 venir pour maintenir l\u2019augmentation de la d\u00e9pense de sant\u00e9 entre 2 et 3 %.\u00a0<\/span><\/p>\n<h1 class=\"para-TC_inter_01\"><span class=\"char-of-TC_inter_01-29\">Analyse m\u00e9dicalis\u00e9e\u00a0des d\u00e9penses\u00a0<\/span><\/h1>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">L\u2019atout majeur du rapport de la Cnam repose sur une analyse m\u00e9dicalis\u00e9e des d\u00e9penses d\u2019assurance maladie via une d\u00e9composition rigoureuse des remboursements par pathologie. \u00c0 titre d\u2019exemple, en 2011, les pathologies et facteurs de risque cardio-vasculaires repr\u00e9sentent 30,2 milliards d\u2019euros, soit 20,7 % du total des remboursements. Pr\u00e9cis\u00e9ment, au sein des pathologies, certaines dominent en termes de co\u00fbt : la maladie coronaire, l\u2019accident vasculaire c\u00e9r\u00e9bral (AVC), l\u2019insuffisance cardiaque et les troubles du rythme. On peut y ajouter les traitements des facteurs de risque cardio-vasculaire que sont le diab\u00e8te, l\u2019hypertension art\u00e9rielle et l\u2019hyperlipid\u00e9mie. Par ailleurs, les autres principaux postes de d\u00e9penses sont imputables \u00e0 la politique de sant\u00e9 mentale (22,6 milliards d\u2019euros), au traitement des cancers (14,5 milliards d\u2019euros, soit 10 % des d\u00e9penses totales) et des affections chroniques.<\/span><\/p>\n<blockquote>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">Les mesures d\u2019\u00e9conomie pour 2014 restent le prolongement de politiques men\u00e9es depuis quelques ann\u00e9es, tant sur l\u2019offre que sur la demande de soins de sant\u00e9.<\/span><\/p>\n<\/blockquote>\n<h1 class=\"para-TC_inter_01\"><span class=\"char-of-TC_inter_01-29\">Propositions\u00a0<\/span><\/h1>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">Une fois ce diagnostic pos\u00e9, la Cnam avance vingt-sept propositions concr\u00e8tes r\u00e9sum\u00e9es en quatre axes structurants pour p\u00e9renniser le syst\u00e8me d\u2019assurance maladie actuel et ne pas l\u2019engager dans une course au d\u00e9ficit :\u00a0<\/span><\/p>\n<ul>\n<li class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-109\">informer le patient<\/span>\u00a0<span class=\"char-TC_txt-Local-83\">dans ses choix pour favoriser la pr\u00e9vention et la pertinence des soins :<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; lutte contre le tabagisme,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; am\u00e9lioration des campagnes de sant\u00e9 publique,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; information sur les interactions m\u00e9dicamenteuses et d\u00e9veloppement d\u2019outil d\u2019aide \u00e0 la d\u00e9cision en lien avec les recommandations de la Haute Autorit\u00e9 de sant\u00e9 (HAS), notamment concernant les interventions type canal carpien, appendicectomie et proth\u00e8se de hanche ;\u00a0<\/span><\/li>\n<li class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-109\">am\u00e9liorer la qualit\u00e9 des soins et optimiser les processus de soins<\/span>\u00a0<span class=\"char-TC_txt-Local-83\">:<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; audit de parcours patients, notamment pour les affections chroniques, les personnes \u00e2g\u00e9es d\u00e9pendantes et les polypathologies,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; ajustement des tarifs pour les op\u00e9rations de la cataracte,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; revue du protocole pour les reprises d\u2019intervention en orthop\u00e9die,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; optimiser la r\u00e9\u00e9ducation postop\u00e9ratoire ;<br \/>\n<\/span><\/li>\n<li class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-109\">am\u00e9liorer les parcours des personnes \u00e2g\u00e9es et leur prise en charge<\/span>\u00a0<span class=\"char-TC_txt-Local-83\">: l\u2019enjeu est d\u2019\u00e9viter les hospitalisations longues suite \u00e0 un passage aux urgences, lorsqu\u2019elles peuvent l\u2019\u00eatre par un travail de pr\u00e9vention en amont. Il s\u2019agit \u00e9galement de veiller \u00e0 l\u2019aval, avec le retour \u00e0 domicile dans de bonnes conditions, en assurant le suivi, les soins et les aides n\u00e9cessaires ;<\/span><\/li>\n<li class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-109\">mobiliser les marges de man\u0153uvre dans les diff\u00e9rents secteurs d\u2019offre de soins<\/span>\u00a0<span class=\"char-TC_txt-Local-83\">:<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; incitation tarifaire au d\u00e9veloppement de la chirurgie ambulatoire,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; alignement des prix des m\u00e9dicaments g\u00e9n\u00e9riques sur ceux de pays comparables (Allemagne, Angleterre),<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; r\u00e9duire drastiquement le prix du Lucentis dans le traitement de la d\u00e9g\u00e9n\u00e9rescence maculaire li\u00e9e \u00e0 l\u2019\u00e2ge (DMLA), premier m\u00e9dicament de ville rembours\u00e9, avec pr\u00e8s de 390 millions d\u2019euros,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; encadrer la forte augmentation de la prescription des nouveaux anticoagulants oraux (Naco), notamment pour des patients tr\u00e8s \u00e2g\u00e9s,<br \/>\n<\/span><span class=\"char-TC_txt-Local-83\">&#8211; encourager, pour les patients dont l\u2019\u00e9tat de sant\u00e9 est compatible, l\u2019usage des v\u00e9hicules personnels, beaucoup moins co\u00fbteux pour l\u2019Assurance Maladie que la prise en charge syst\u00e9matique en ambulance ou v\u00e9hicule sanitaire l\u00e9ger.\u00a0<\/span><\/li>\n<\/ul>\n<h1 class=\"para-TC_inter_01\"><span class=\"char-of-TC_inter_01-29\">\u00c9volution pr\u00e9visible Ondam 2014 &#8211;\u00a0Synth\u00e8se des mesures d\u2019\u00e9conomie\u00a0<\/span><\/h1>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">Analysant les d\u00e9penses constituant l\u2019Ondam en 2012 et les r\u00e9alisations pr\u00e9visionnelles pour 2013 retenus par la commission des comptes de la s\u00e9curit\u00e9 sociale, la Cnam anticipe une progression annuelle de +2,9 % soit une progression de l\u2019Ondam de 170,3 milliards d\u2019euros \u00e0 175,2 milliards d\u2019euros. L\u2019ann\u00e9e 2014 devrait quant \u00e0 elle, poursuivre cette augmentation avec une d\u00e9pense pr\u00e9visionnelle estim\u00e9e \u00e0 182milliards d\u2019euros soit +3,8 %. Afin de respecter un taux de progression de l\u2019Ondam fix\u00e9 \u00e0 2,4 %, la Cnam propose des mesures d\u2019\u00e9conomies chiffr\u00e9es \u00e0 2,5 milliards d\u2019euros.\u00a0<\/span><\/p>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">Parmi ces mesures, la Cnam met en avant certaines actions structurantes: \u00e9volution des tarifs des m\u00e9dicaments et de dispositifs m\u00e9dicaux, actions classiques de ma\u00eetrise m\u00e9dicalis\u00e9e et d\u2019efficience des prescriptions, d\u00e9veloppement de l\u2019aval (soins de suite et r\u00e9adaptation, accompagnement des personnes \u00e2g\u00e9es d\u00e9pendantes), r\u00e9flexion sur la pertinence des actes et la juste prescription, d\u00e9veloppement de l\u2019ambulatoire et baisse des surcapacit\u00e9s de chirurgie avec hospitalisation compl\u00e8te et renforcement de la politique achat (projet Phare &#8211; Performance hospitali\u00e8re pour des achats responsables) ainsi de la politique de contractualisation de la performance (Agence nationale d\u2019appui \u00e0 la performance des \u00e9tablissements de sant\u00e9 &#8211; Anap).\u00a0<\/span><\/p>\n<h1 class=\"para-TC_inter_01\"><span class=\"char-of-TC_inter_01-29\">Conclusion\u00a0<\/span><\/h1>\n<p class=\"para-TC_txt\"><span class=\"char-TC_txt-Local-83\">Le rapport de la Cnam poss\u00e8de l\u2019avantage incontestable de fournir une information m\u00e9dicalis\u00e9e sur les d\u00e9penses de l\u2019Assurance Maladie, ce qui lui permet de proposer des actions pr\u00e9cises, notamment sur certains types d\u2019actes chirurgicaux courants ou sur des m\u00e9dicaments on\u00e9reux substituables. Les mesures d\u2019\u00e9conomie pour 2014 restent toutefois le prolongement de politiques men\u00e9es depuis quelques ann\u00e9es, tant sur l\u2019offre que sur la demande de soins de sant\u00e9. Elles s\u2019accordent sur ce point avec la feuille de route de la Strat\u00e9gie nationale de sant\u00e9, d\u00e9voil\u00e9e le 23 septembre par la ministre de la Sant\u00e9, et dont l\u2019ambition est de corriger en profondeur les dysfonctionnements de notre syst\u00e8me de sant\u00e9.<\/span><\/p>\n<p class=\"para-TC_txt\"><strong>Pour en savoir plus : <\/strong><a href=\"http:\/\/www.ameli.fr\/rapport-charges-et-produits-2014\/appli.html\" target=\"_blank\" rel=\"noopener noreferrer\">www.ameli.fr<\/a><\/p>\n<script>function PlayerjsAsync(){} if(window[\"Playerjs\"]){PlayerjsAsync();}<\/script>","protected":false},"excerpt":{"rendered":"<p><span class=\"span-reading-time rt-reading-time\" style=\"display: block;\"><span class=\"rt-label rt-prefix\">Temps de lecture\u00a0: <\/span> <span class=\"rt-time\"> 4<\/span> <span class=\"rt-label rt-postfix\">minutes<\/span><\/span>\ufeffLe 11 juillet 2013, la Caisse nationale d\u2019assurance maladie (Cnam) a remis au ministre charg\u00e9 de la S\u00e9curit\u00e9 sociale et au Parlement un rapport sur l\u2019\u00e9volution des charges et des produits de l\u2019Assurance Maladie. Ce rapport pose un diagnostic complet des \u00e9volutions r\u00e9centes des d\u00e9penses d\u2019assurance maladie en sp\u00e9cifiant pr\u00e9cis\u00e9ment les enjeux de sant\u00e9 publique auxquels la soci\u00e9t\u00e9 doit faire face sans pour autant alourdir la contribution nationale.<\/p>\n","protected":false},"author":1202,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[26,2],"tags":[1076,4160,1239,870,1461,1460,1459],"class_list":["post-15626","post","type-post","status-publish","format-standard","hentry","category-dossier","category-gestions-hospitalieres","tag-assurance-maladie","tag-cnam","tag-depenses","tag-ondam","tag-propositions","tag-rapport-igas","tag-rapport-igs"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Qualit\u00e9 du syst\u00e8me de sant\u00e9 et ma\u00eetrise des d\u00e9penses - Gestions hospitali\u00e8res<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Qualit\u00e9 du syst\u00e8me de sant\u00e9 et ma\u00eetrise des d\u00e9penses - Gestions hospitali\u00e8res\" \/>\n<meta property=\"og:description\" content=\"Temps de lecture\u00a0:  4 minutes\ufeffLe 11 juillet 2013, la Caisse nationale d\u2019assurance maladie (Cnam) a remis au ministre charg\u00e9 de la S\u00e9curit\u00e9 sociale et au Parlement un rapport sur l\u2019\u00e9volution des charges et des produits de l\u2019Assurance Maladie. Ce rapport pose un diagnostic complet des \u00e9volutions r\u00e9centes des d\u00e9penses d\u2019assurance maladie en sp\u00e9cifiant pr\u00e9cis\u00e9ment les enjeux de sant\u00e9 publique auxquels la soci\u00e9t\u00e9 doit faire face sans pour autant alourdir la contribution nationale.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/\" \/>\n<meta property=\"og:site_name\" content=\"Gestions hospitali\u00e8res\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/gestionshospitalieres\/\" \/>\n<meta property=\"article:published_time\" content=\"2013-11-30T23:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2018-03-07T16:22:34+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2016\/10\/ill_2013_612_01-215x300.png\" \/>\n<meta name=\"author\" content=\"yann Le Sager\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@revue_GH\" \/>\n<meta name=\"twitter:site\" content=\"@revue_GH\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"yann Le Sager\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/\"},\"author\":{\"name\":\"yann Le Sager\",\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/#\/schema\/person\/810c9671279c5f5a094f6f0a42237516\"},\"headline\":\"Qualit\u00e9 du syst\u00e8me de sant\u00e9 et ma\u00eetrise des d\u00e9penses\",\"datePublished\":\"2013-11-30T23:00:00+00:00\",\"dateModified\":\"2018-03-07T16:22:34+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/\"},\"wordCount\":1044,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/gestions-hospitalieres.fr\/wp-content\/uploads\/2016\/10\/ill_2013_612_01-215x300.png\",\"keywords\":[\"assurance maladie\",\"Cnam\",\"d\u00e9penses\",\"Ondam\",\"propositions\",\"rapport Igas\",\"rapport IGS\"],\"articleSection\":[\"dossier\",\"Gestions Hospitali\u00e8res\"],\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/\",\"url\":\"https:\/\/www.ricom-web8.com\/gestions\/qualite-du-systeme-de-sante-et-maitrise-des-depenses\/\",\"name\":\"Qualit\u00e9 du syst\u00e8me de sant\u00e9 et ma\u00eetrise des d\u00e9penses - 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