Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
Quelles solutions pour la garde en médecine générale? - KCE
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122<br />
Items<br />
Financer and<br />
financing system<br />
Characteristics off<br />
model most frequ<strong>en</strong>tly<br />
used<br />
Critical success<br />
factors<br />
Guidelines<br />
according to three criteria of seve erity (urg<strong>en</strong>t medical aassistance,<br />
medical coonsultation<br />
within the half-day, counselling).<br />
After-hours care annd<br />
urg<strong>en</strong>t<br />
medical assisstance<br />
may be manag ged separately but the two managem<strong>en</strong>t c<strong>en</strong>ntres<br />
are interconnecteed.<br />
Legal framewwork:<br />
the public health code applied nationwwide.<br />
Betwe<strong>en</strong> 20004<br />
and 2007, the SHI budget dedicated to PPDS<br />
(‘perman<strong>en</strong>ce dees<br />
soins’) increased frrom<br />
€270 million to €3350<br />
million (that is, 4.44%<br />
of the<br />
total SHI feess<br />
of self-employed phy ysicians), showing a ree<strong>la</strong>tive<br />
success in devveloping<br />
the system.<br />
After-hours care<br />
is g<strong>en</strong>erally subjec ct to f<strong>la</strong>t-rate remunerration.<br />
Hourly paymm<strong>en</strong>t<br />
for regu<strong>la</strong>ting se elf-employed doctors – paym<strong>en</strong>t of time oon<br />
call for after-hourss<br />
doctors (per duty ssession)<br />
specific additions<br />
per<br />
procedure.<br />
Hourly rates ffor<br />
the regu<strong>la</strong>ting doct tors with higher fees foor<br />
care provided and a time-slot-based on-ccall<br />
care paym<strong>en</strong>t formmu<strong>la</strong>.<br />
Initiator: After-hours<br />
service provis sion is organized and regu<strong>la</strong>ted by regional authorities comprisinng<br />
indep<strong>en</strong>d<strong>en</strong>t bodiess<br />
of g<strong>en</strong>eral practitioners.<br />
Both<br />
hospitals andd<br />
GPs initiate the servi ice based on agreeme<strong>en</strong>ts<br />
determined by thee<br />
ARS for a period of ffive<br />
years.<br />
Number of GGPs<br />
taking part in afte er-hours care: Accordding<br />
to a 2009 cross-national<br />
survey, 78% % primary care practicces<br />
in France offer affter-hours<br />
arrangem<strong>en</strong>tss<br />
whereby pati<strong>en</strong>ts co ould see a physician oor<br />
nurse without visitinng<br />
the ED. An estimatted<br />
number of 300 GPPs<br />
are taking part in thhe<br />
on-call<br />
medical c<strong>en</strong>trres<br />
(primary care c<strong>en</strong>t tres).<br />
Number of Ammbu<strong>la</strong>tory<br />
care c<strong>en</strong>tre es: Not known<br />
Popu<strong>la</strong>tion: NNot<br />
known<br />
Distance: Not<br />
known<br />
Indication: Intt<strong>en</strong>ded<br />
for urg<strong>en</strong>t help p requests that cannott<br />
wait until the next dayy<br />
Avai<strong>la</strong>bility off<br />
after-hours care:<br />
Usual op<strong>en</strong>inng<br />
times: from 8 p.m. to 8 a.m. (nights fromm<br />
Monday to Friday) aand<br />
from 10 p.m. to 8 a.m. on the followingg<br />
working day on WE or public<br />
holidays.<br />
Time frame foor<br />
answering to calls: Betwe<strong>en</strong> 1 and 15 minutes.<br />
Time frame foor<br />
urg<strong>en</strong>t and non-urg<strong>en</strong>t<br />
visits: see above<br />
Location: Situuated<br />
near or within a hospital, but there is ooft<strong>en</strong><br />
no regu<strong>la</strong>ted floww<br />
betwe<strong>en</strong> them.<br />
Access: Therre<br />
are three ways of ac ccessing by phone. Thhrough<br />
the ‘c<strong>en</strong>tres 155’,<br />
or a phone numberr<br />
linked to the c<strong>en</strong>tres or through a direct phone<br />
call.<br />
Workload GPPs:<br />
Not known<br />
Services:<br />
Telephone seervice<br />
Home visits<br />
Consultation in ambu<strong>la</strong>tory care ce <strong>en</strong>tre<br />
Staff involvedd:<br />
GPs, specialists, nu urses and administrativve<br />
personnel<br />
Logistic suppport:<br />
Not specified<br />
Information aand<br />
communication tec chnology: Not specifieed<br />
Not specified<br />
Not specified<br />
Affter-Hours<br />
Primaary<br />
Care<br />
Resullts<br />
<strong>KCE</strong> Reportss<br />
171
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