[The medical service of sickness insurance: its future]. / Le service médical de l'assurance maladie: son avenir.

ABSTRACT

Since its creation, the Medical Service of Health Insurance has known an important evolution. Initially, its essential role was to control the allowances paid to the insured persons of the regimes of Health Insurance. Its aspect was rather coercive. But since 1960 a change has been outlined with the creation of the "Haut Comité Médical de la Sécurité Sociale" the Medical Control left its place to the Medical Service. With this denomination, its functions never stopped expanding. The Medical Service maintained its tasks of control devolved by the different regulations, and that is how it falls to it to express a view about long term diseases, disability occupational injuries, etc. It is also responsible for setting up "selective" controls with regard to some of medical or ancillary medical acts. But this taskwork is coupled with an important activity the counsel. This responsibility is orientated in three directions the Health Insurance Associations, the insured persons, and the Health Professions particularly as a part of the conventions binding them to the organizations of the French social protection system. During these last years new date intervened in health insurance matters in consequence of the economical crisis. Henceforward, it suits to find just a balance between a social protection of a high standard and adapted care of quality for the best cost. New opportunities are offered to the Medical Service to face this situation and gave it also a fresh impulse. This new evolution fits into an activity of public health considering the progress of the medicine. This activity must be orientated to a better knowledge of dispensed care and its good employment. Several orientations must be detained. In disease matters, informations in possession of the medical services are to be operated and, thanks to the data processing, a balance sheet of expenses will be drawn up, comparing them with diagnostic and therapeutic means. These studies, whose results will be published, must be guided with an exemplary scientific strictness and be supported by uncontested leading people in the medical world. Hospitalization is the other field where the role of the medical service must be essential. It certainly charges to continue the individual controls. But it must go further and be interested in the hospital working, as well as in the aggregate as by hospital service. This permits to get indispensable informations for useful decisions in view of a better hospitalisation.(ABSTRACT TRUNCATED AT 400 WORDS)