The protest by private practice doctors against the 2026 Social Security budget has found unexpected support at the highest levels of the Health Insurance system. During a hearing on January 14th before the Senate's Social Affairs Committee, the Director General of Health Insurance The Director of Health Insurance has publicly distanced himself from two legislative provisions that have sparked outrage among healthcare professionals. At issue are articles allowing the State to unilaterally set medical fees if collective bargaining agreements fail, a mechanism deemed counterproductive even by those theoretically responsible for implementing it. General practitioners are engaged in a ten-day strike, from January 5th to 15th, to denounce what they perceive as an undermining of the collective bargaining process. Articles 77 and 78 of the 2026 Social Security Financing Law, introduced by amendment in the National Assembly, effectively give health authorities the power to revise certain fee schedules without prior agreement from unions. This signal is perceived as a direct threat by the profession. Before the senators, the Director of Health Insurance emphasized a clear break with this approach. He explained that he had never considered, nor desired, a mechanism allowing for the unilateral reduction of doctors' fees, believing that this approach ran counter to the policy pursued by the institution he leads. He argued for the swift repeal of these articles, which he claimed were adopted against the government's own advice, in order to restore a climate of trust with practitioners.
A conventional dialogue claimed as a red line
This stance reinforces the one already expressed by the Minister of Healthwho, at the end of December, reiterated her opposition to these provisions and her commitment not to use them while in office. The political context, however, adds further uncertainty, as several ministers have held the position at the Ministry of Health on Avenue Duquesne in recent years, and the ministerial future remains contingent on the upcoming elections. Beyond the legal debate, the Director of Health Insurance emphasized his commitment to the contractual framework, presented as the historical foundation of relations between the institution and private practice physicians. He recalled the agreement signed in June 2024 with five of the six representative unions, a key document providing for a total financial commitment of €1,6 billion to increase medical fees. This agreement notably formalized the increase in the general practitioner consultation fee to €30 for practitioners in sector 1, as well as comparable increases for several clinical specialties, such as pediatrics and psychiatry. It also includes a commitment to increase the reimbursement rates for technical procedures, backed by a specific allocation of €240 million, the distribution of which is still to be finalized. For the management of the National Health Insurance Fund, these elements demonstrate a willingness to compromise and invest sustainably, which is difficult to reconcile with the idea of an authoritarian takeover of tariffs. The official stated his desire for a swift resumption of discussions with representatives of physicians, believing that dialogue remains the only viable way to improve the system.
A real but contained mobilization
The initial effects of the strike were also discussed during the hearing. According to data from submitted medical claims, the activity of general practitioners reportedly declined by 10 to 15% over the period, while that of specialists decreased by approximately 5%. These are significant figures, but nothing compared to the mobilization of October 2023, which resulted in a drop in activity of nearly 30%. This difference illustrates both a continued capacity for mobilization and a desire, on the part of doctors, to maintain a minimum level of continuity of care. For the National Health Insurance Fund, these indicators confirm the urgent need for a swift resolution to prevent the conflict from becoming entrenched. By explicitly calling for the repeal of Articles 77 and 78, the Director General is sending a clear political message. The aim is to close a legislative loophole that is fueling mistrust and to refocus the debate on the ongoing negotiations. It now remains for the legislator to decide between maintaining a controversial coercive tool and fully restoring dialogue with a profession already tested by years of tension.
