Did Social Security really stop caring for strokes on March 1st?

Unfortunately, it is very common for strokes to no longer be reimbursed by Social Security? Internet users have been talking about this for several days: “As of March 1, thromboaspiration catheters are no longer covered”we read in social networks, and with him “stroke treatment”. Statements that suggest that patients will be forced to bear the burden of these costs.

At the same time, transphobic publications are multiplying, drawing a parallel with gender reassignment operations that would be fully covered. If the conditions of withdrawal have indeed changed, the messages that are very widely circulated are distorting reality when they are not completely misleading.

When a patient has a stroke and one of their arteries is blocked, doctors may use catheters for thromboaspiration. They are used to make “mechanical thrombectomy (TM)”and are used in 50-70% of cases. This is a fairly innovative technique in France that has been developed over the past decade. This is welcomed by experts, who consider it a significant achievement, reducing the risk of death and serious consequences.

Until March 1, these catheters were listed in LPP, “a list of products and services that are reimbursed by the health insurance program”. In particular, they were “list above”A “a pejorative funding system designed to support and disseminate innovation in healthcare facilities for certain high-value products and related services”as reported to TF1info in the Ministry of Health. “By enrolling on this list, products and services may be covered in addition to service prices”we’ve been told.

Specifically, when these materials were used, the hospital received a sum of money in addition to the package normally paid for stroke treatment. This is no longer the case as of March 1 as health authorities believe that “if a product can be funded by hospitalization benefits, then it should not appear on the supplementary list”.

In a letter addressed to Minister François Brown, the French Society for Neuroradiology (SFNR) and the French Neurovascular Society (SFNV) were affected by this modification. The text points to “decision made without consultation” which exposes you to several risks. first of all a “non-use of thromboaspiration technique […] in existing centres, which can lead to loss of opportunities for patients. In fact, it is important to have a complete therapeutic arsenal to be able to take care of each patient individually and in an adapted way.”

Then fear “additional costs for facilities performing TM”as this is not yet practiced in all hospitals, especially in smaller hospitals. Finally, professionals fear “influencing the new centers that initiate or will initiate the technique.”

The director of the Rothschild Foundation hospital in Paris believes “450,000 euros in irretrievable losses for the year” with the end of the return. “Huge”, it launches information about France. The medical device discussed here updated for any new intervention is not provided. It is estimated that its average cost is around 1500 euros per set.

“Every time I had to use equipment of this kind, special prices were allocated”summarizes TF1info Sonya Alamovich, president of SFNV. “There has been a change in the way it is funded, which means more specific care in favor of being included in the cost of general patient care.” The problem in his eyes is simple: it “a type of treatment that exists but remains largely deficient and still under development.” To continue its adoption and summarize its usage, “accompanying financial assessment helped”.

“There is a real danger that this decision will become a brake when an accelerator is needed”Sonya Alamovich continues. She insists that it “therapeutic revolution” and that France is lagging behind, especially in relation to Germany. Brakes, in his opinion, should be avoided, as they are synonymous “potential loss of chance” for patients. Not forgetting, she adds, “increased risk of complicating the financial situation of the hospital, which is already precarious.”

“Delisting additionally does not mean the refund has been revoked”for its part, the Ministry of Health notes. “As of March 1, 2023, these hospital-only products have been reintegrated to cover them in hospitalization services.”

In François Braun’s entourage, it is specified that “The exclusion of these devices from the list additionally corresponds to 0.22% of the costs of medical devices additionally registered in the list and 0.015% of the tariff mass of healthcare organizations.” An indirect response to the speeches of heads of institutions who fear the growth of their costs. Moreover, “The selection of this category for possible delisting additionally in 2023 was discussed as early as 2021 with the actors”. Therefore, it is not surprising, from the point of view of the Ministry of Health.

For support in 2023 “most consuming establishments” these medical devices “envelope for 9.3 million euros” However, it is planned, we will find out. This will concern “two categories abolished as of March 1, 2023: FFR guides and thromboaspiration catheters”. Finally, note that activity-based pricing has been revised upwards. “from 5 to 8% depending on the type of institution (public / private)”. Fixed prices applied in stroke treatment will be affected like others.

Will these additional resources be enough to reassure doctors and medical leaders? The stakes are huge, they remind, as by 2030 a projected boom of 50% of strokes is expected in absolute terms. Baby boomers will indeed appear in large numbers at the age when these vascular accidents usually occur. A public health priority as it is estimated that one in four people will experience a stroke in their lifetime.

Do you want to ask us questions or provide information that you do not believe is reliable? Feel free to write to us at lesverifié[email protected] You can also find us on Twitter: our team is there on @verif_TF1LCI.