140 euros for a delivery to the hospital against 2

Gynaecologists-obstetricians Union threatens to strike of deliveries. How has it happened Deliveries are made less clinical, by liberal obstetricians: 50 a few years ago, it got less than 30. The hospital takes over, with serious difficulties: alone in Rhône-Alpes region, for example, 50 hospital practitioners of this specialty positions are not filled. This is costly for health insurance. Indeed, in 2008, it paid on average 3.140 euros for a delivery to the hospital against 2.742 euros in clinic.

This surplus of EUR 63 million is due to the abandonment of the obstetrics service by liberal physicians. Addition of other additional costs: hospitals must invest in facilities to births, while equipment become underemployed in clinics; women give birth with a lesser medical presence, while competent gynaecologists take out delivery rooms.

What is it that causes this evolution for families and costly for health insurance The inertia of the authorities to the problem of the civil liability of gynaecologists-obstetricians. Insurance sensu stricto is made to cover risks probabilisables. But the risk of being condemned to pay heavy compensation to a person born sometimes twenty years previously, or his parents, following a serious error during pregnancy or childbirth, follow-up is not probabilisable: the "law of big numbers", basis of insurance, does not apply (the cases are too rare); legal rules and the case law changing rapidly, so that those that apply to the loss may differ from those who formed the basis for pricing; and the propensity of victims to claim compensation varies from foreseeably difficult.

Under these conditions the insurers are brought to very high rates: in exchange for risk of loss, they want a strong expectation of gain. The annual premium paid by a gynaecologist-obstetrician is now of the order of 15,000 to roughly 38,000 euros, for coverage limited to 3 to 6 million loss. However it is already currently that a tribunal awards compensation twice superior; the practitioner short so the risk of be taxed in ten or twenty years 3, 5 or 10 million: the absolute ruin. Oniam (national Board of medical compensation) the complainants will be totally buy-offs, but the midwife will have lost all his property. Many consider better to abandon obstetrics (approximately 20 of their income) of an increase of their activity in medical gynaecology... or a less stressful life.

In addition, as Medicare does support that part of the insurance giant, their growth premiums leads to the increase in the price of acts, thereby paying households that social security holds back finance.

Total contributors and patients pay high price (30 to 40 more) coverage liability of Obstetricians who leaves the risk of ruin and causing the abandonment of the profession. This because the authorities do not want that the social security system itself handles this coverage by pooling.

The General Inspectorate of health and Social Affairs was almost the same analyses, but without leading to conclusions very clear. The best would be to entrust to the Oniam the full support of the civil liability of Obstetricians risk (and perhaps of other specialties, should study the issue). Otherwise, if the authorities are keen to let insurance is a risk that is logically another form of mutualization that they allow the Oniam to cover which exceeds the ceiling (3 million currently, in General) supported by the insurance. This "second best" would be an unnecessary expenditure of several million per year, but it would be less serious and less expensive than euthanasia of the Liberal exercise of obstetrics to which we are witnessing.