in medical deserts, health taxis ulcerated by the budget

They turned on their hazard lights. In the early morning, more than 150 taxis were gathered in single file on one of the main roads leading to Lyon (Rhône). Some came from the Loire, Côte d'Or, Isère to slow down traffic and show their signs “Taxis on strike” or “Medical taxi in danger”. Similar mobilizations have taken place in Marseille, Toulouse, Paris and even Angers in recent days. “It’s starting to heat up, and that’s normal! »breathes Geoffrey, taxi in Corrèze. From one end of France to the other, the drivers' demand is the same: that the government renounce the savings envisaged on the transport of customers on medical prescription, reimbursed by Health Insurance.

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Each year, reimbursement for taxis for people needing to be taken to a consultation, particularly in rural areas, costs Social Security 3 billion euros. A figure that is increasing due to the growing shortage of caregivers, who must be sought from further and further afield. So the government, which is preparing a budgetary tightening in health, wants to reduce this expenditure item by 300 million euros. How ? It is up to taxis and Health Insurance to find common ground for the 2025-2029 convention. If they do not succeed, the Social Security financing bill, which is causing great tension in the National Assembly and for which Michel Barnier took responsibility for his government on December 2 by triggering the article 49.3, plans to impose tariff reductions.

So you have to find where to cut corners. The National Health Insurance Fund (CNAM) is therefore proposing new lower pricing for medical transport, and a reinforced obligation to provide “shared taxi”further forcing people benefiting from reimbursement for transport to a health center to share the vehicle. The measure would also increase the waiting time of customers, who, according to the drivers involved, would be the first victims. Victims located for the most part, unsurprisingly, in medical deserts.

From patient to package

If customers already have the obligation to agree to share the ride – unless they pay extra – “they want to increase this mode of transport”explains Geoffrey, who fears that this measure will impoverish exchanges with customers. The 2024 Social Security financing law has already tightened the conditions for medical transport. It provides that a patient can no longer refuse shared medical transport (unless the doctor specifies that their state of health is incompatible), under penalty of having to advance the costs and being reimbursed only on the basis of the shared transport. . From 2025, a penalty must also apply.

An eventuality which upsets professionals used to these medical transports. “There are people who we take every week, sometimes even several times a week, because they have very regular treatments. Obviously, we discuss, we know them well, we try to appease them. Is it possible if there are three or four of us in the car for more than an hour? »he still insists. In areas deserted by health professionals and public services, taxis are sometimes the only regular social connection for patients.

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“The patient is not a guy you take to the airport or to a nightclub or to the hairdresser. He's someone who looks forward to you because you may be the only person he sees during the week and it's an outing for him. He tells you about his little ailments, he talks to you about his little family, you take him to the hospital, sometimes you even help him get dressed when he is discharged from hospital”also reminded AFP Abdel Grine, president of the Federation of Independent Taxis of the Rhône (FTI69).

“We are just comparing ourselves to parcel carriers. Except we are transporting humans”further pleads the representative. Another risk pointed out in particular by the association of patients with renal pathologies Renaloo: the potential transmission of infectious diseases during transport. In fact, patients needing dialysis sometimes have to go to the hospital three times a week. Traveling with other people “will expose them to respiratory viruses, while they are severely immunocompromised, and at very high risk of serious illness, particularly covid”alarms the association.

Prolonged wait

Renaloo worries and fears too “singularly increased waiting and transport times, and just as much fatigue imposed on top of that” while patients on dialysis are already “fragile and exhausted by the treatments and by their state of health”. In fact, with several customers in the vehicle, the driver must necessarily make additional stops and detours, and potentially stay for a certain period of time at a health establishment to wait for another patient. “Not only will we wait a very long time to fill the car, we will make endless rounds, but we will also deteriorate the service that we have put in place for years with patients”told AFP Abdel Grine, in the Rhône.

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The regulatory text in preparation, revealed by franceinfo and consulted by AFP at the end of November, provides that this shared transport generates a maximum “ten kilometers of detours” per patient, “within the limit of 30 km” in total per trip. He also says that the patient will not have to wait more than 45 minutes in total at the point of care, whether before or after their appointment.

However, this deadline has already passed, according to drivers, particularly in rural areas. “We already have to make clients wait an hour or more after the end of a chemo session”explains Geoffrey again.

From the Millevaches plateau, where he works, a detour can quickly become very, very long. The nearest large hospitals, where many patients must go for regular care, are more than an hour's drive away: Clermont-Ferrand, Limoges, Brive-la-Gaillarde, etc.

Revenues down

“That’s what bothers us, much more than the fact that they want to make us drive at 0.98 cents per kilometer instead of 1.67 euros”assured Abdel Grine, in reference to the decline in the quality of service for patients. The fact remains that the anger also necessarily relates to the loss of purchasing power for taxis. Because if the State pays less, the shortfall will be as much. For some taxis, medical transport represents 60%, even 70% of revenue. “And in rural areas, up to 98%, illuminates the Corrézien. It’s my job, there are weeks when I go just once to pick someone up at the station”. The rest of the days are spent traveling back and forth between hospitals, accommodation, consulting rooms, etc.

There are also a lot of additional logistics to ensure, so that everyone's agendas are compatible. What if two patients end up at the same hospital 1.5 hours apart? If another is sold out, but a detour is necessary? “With medical transport customers, we have a social role. We can't just tell them to sit down and not pay attention to their needs.”Geoffrey still insists. Yes, but social is not profitable.