Advanced Search

Act No. 2002 - 1487 20 December 2002 Funding Of Social Security For 2003

Original Language Title: LOI n° 2002-1487 du 20 décembre 2002 de financement de la sécurité sociale pour 2003

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.
Learn more about this text...

Information on this text

Application texts

Summary


This Social Security Financing Act for 2003 is presented by the Government as a transitional law before the reforms made necessary by the impossibility of achieving the balance of social security financing. The attached report, adopted by Title I, announced a Public Health Programming Act for the spring of 2003, as well as a corrective funding law in the event of the anticipated balance. The Hospital Plan 2007 will be based on the regionalization of heavy investments, the use of delegated works masters, and a capital contribution to renew the hospital park. Title II (sections 2 to 9) deals with the monitoring of the application of social security financing laws. Its article 2 includes a new parliamentary office for health policy evaluation. Title III (articles 10-21) deals with resources for social security financing. Sections 10 and 11 increase the tax of tobacco and amend the allocation of income to the health insurance fund of employed workers (CNAMTS). Article 11 transposes the provisions of Directive 2002/10/EC of 12-02-2002 on fixing taxes by a threshold expressed in the amount per thousand cigarettes. The overall revenue forecast for 2003 is set by Article 20 to 327.51 billion euros, compared to 315.20 for 2002 (Article 21). Title IV (sections 22 to 51) deals with health insurance. Section 29 removes the system of floating keywords, as well as regional medical committees. To better control the increase in drug refunds, the lump-sum rate of liability is established by section 43: all medicines belonging to the same generic group will be reimbursed according to this tariff, fixed by Order of Ministers of Health and Social Security after notice of the Economic Committee for Health Products. Article 42 postpones the period, initially set at 31 December 2003, for tripartite conventions that condition the payment of the personalized self-reliance allowance to persons housed in reception facilities. Article 50 sets the national obejctive for health insurance expenditures to €136.35 billion in 2003, compared to $16.7 billion in 2002 (Article 51). Title V deals with other social security sectors: occupational accidents and occupational diseases (articles 52 to 57, setting a target of 9.4 billion euros in branch spending); family (articles 58 to 60, setting the target of branch spending to 43.62 billion); old age (articles 61 to 63, with a target of 140.36 billion branch expenditures). Pension revalorization is set for 2003 at 1.5% (Article 61). Finally, securities VI and VII set the revised expenditure target for 2002 and cash measures respectively. CODE OF FINANCIAL LEGICTIONS: creation of Article L.132-3-2. L165-1, L131-10, L241-2, L245-4, L138-11, L380-3, L161-1, L162-22-2, L162-22-2, L162-22-8, L162-5-9, L162-5-13, L162-45, L162-5-15 GENERAL CODE OF IMPOTS: Amendments to Articles 572, 572 bis, 575, 575 A, 575 C. PUBLIC HEALTH CODE: Amendments to Articles L5123-3, L3511-1, L3511-6, L6122- 19, L6161-9, L3411-2, L6312-5, L5121-1, L5121-20, creation of Article L6325-1. CODE OF SOCIAL ACTION AND FAMILY: Amendments to Articles L314-3, L314-8, L313-1, L313-12. RURAL CODE: Amendments to Articles L732-5, L732-39. ORDER 58-1100 DU 17-11-1958: creation of Article 6 octiès. LOI 98-1194 DU 23-12-1998: amendments to articles 25, 33 and 41. ORDER 96-50 OF 24-01-1996: Amendments to Articles 2 and 4. LOI 2000-1257 of 23-12-2000: amendments to articles 27, 40, 53. LOI 2001-1246 DU 15-12-2000: modification of articles 36, 43, 47. LOI 78-753 DU 17-07-1978: modification of Article 1. LOI 94-628 of 25-07- 1994: amendment of Article 14. LOI 2001-647 dated 20-07-2001: amendment of Article 5. LOI 88-16 OF 05-01-1988: amendment of Article 4.

Keywords

LFSS 2003 , HEALTH , SOCIAL SECURITY , FINANCING , ONDAM , PLAN , HOPITAL , CONTROL , DEPENSES , RECETTES , PROGRAMME LOI , BRANCHE , EQUILIBRE , TRESORERIE , FILLEN , VIEW ,

Legislative records

Subsequent links




JORF of 24 December 2002 page 21482
text No. 1



LOI No. 2002-1487 of 20 December 2002 on social security financing for 2003 (1)

NOR: SANX0200141L ELI: https://www.legifrance.gouv.fr/eli/loi/2002/12/20/SANX0200141L/jo/texte
Alias: https://www.legifrance.gouv.fr/eli/loi/2002/12/20/2002-1487/jo/texte


The National Assembly and the Senate adopted,
Vu la Decision of the Constitutional Council No. 2002-463 DC of 12 December 2002;
The President of the Republic enacts the following legislation:

  • PART I: ORIENTATIONS AND OBJECTIVES OF HEALTH POLICY AND SOCIAL SECURITY Article 1


    It is approved the report annexed to this Law on Health and Social Security Policy Directions and the objectives that determine the general conditions of the financial balance of social security for the year 2003.

  • PART II: CONTROL OF THE APPLETIONMENT OF THE MONITORING OF SOCIAL SECURITY Article 2


    After Article 6 septies of Order No. 58-1100 of 17 November 1958 relating to the functioning of the parliamentary assemblies, an article 6 octies is inserted as follows:
    "Art. 6 octies. - I. - In order to contribute to the monitoring of social security financing laws, the parliamentary delegation known as the Parliamentary Health Policy Assessment Office is responsible for informing Parliament of the consequences of public health choices in order to clarify its decisions. To this end, it collects information, implements studies programs and conducts evaluations.
    “II. - The delegation is composed of:
    " - presidents of the committees of the National Assembly and the Senate in charge of social affairs as well as of the rapporteurs of these commissions in charge of health insurance under the laws of financing social security;
    " - ten deputies and ten senators appointed to ensure, in each assembly, a proportional representation of political groups, taking into account members of law, each group with at least one representative. Members are appointed at the beginning of each legislature for the duration of the legislature. Senators are appointed after each partial renewal of the Senate.
    "The Office is alternately chaired for one year by the President of the Social Affairs Committee of the National Assembly and by the President of the Social Affairs Committee of the Senate.
    "III. - The delegation is assisted by an expert council composed of six personalities chosen because of their competence in the field of public health.
    "The members of the expert board shall be designated for three years under the terms and conditions set out in the rules of procedure of the delegation.
    "The expert board shall be seized under the conditions provided for by the rules of procedure of the delegation, whenever the delegation considers it necessary.
    "IV. - The delegation may seek advice from health professionals, trade union and professional organizations and health associations.
    “V. - The delegation has before it:
    « 1° The Bureau of one or the other assembly, either at its initiative or at the request of a group chair, or at the request of sixty members or forty senators;
    « 2° A special or permanent commission.

    "VI. - The delegation has the powers defined by the IV of Article 164 of Order No. 58-1374 of 30 December 1958 on the Financial Law for 1959.
    "In the event of difficulties in carrying out its mission, the delegation may request, for a period not exceeding six months, to the assembly from which the referral emanates, to confer on it the prerogatives attributed by Article 6 to the parliamentary commissions of inquiry, their presidents and their rapporteurs. When the delegation enjoys these prerogatives, the provisions relating to the secrecy of the work of the commissions of inquiry are applicable.
    « VII. - The work of the delegation is confidential unless the delegation decides otherwise.
    "The results of the work carried out and the delegation's observations are communicated to the author of the referral.
    "After collecting the author's opinion, the delegation can make them public.
    "However, where the delegation has obtained the benefit of the provisions of Article 6, the decision to publish may only be taken by the interested assembly, under the conditions set out in its regulations for the publication of the reports of the commissions of inquiry.
    « VIII. - The delegation establishes its rules of procedure; the latter is subject to the approval of the Bureaux of the two assemblies.
    « IX. - Expenses for the operation of the delegation shall be financed and carried out as expenses of the two parliamentary assemblies under the conditions laid down in Article 7. »

    Article 3


    After article L. 132-3-1 of the Financial Courts Code, an article L. 132-3-2 is inserted as follows:
    "Art. L. 132-3-2. - As part of its mission to monitor the application of social security financing laws, the Court of Auditors, without prejudice to the provisions of Articles L. 211-1 and L. 211-8, is empowered to collect, in conjunction with the Regional Chambers of Accounts, information from the institutions referred to in Article L. 6141-2 of the Public Health Code. »

    Article 4


    Each year before July 15, the Government shall transmit to Parliament a report which shall present the follow-up to each of the recommendations made by the Court of Auditors in its report on the application of social security financing laws, prepared in accordance with Article LO 132-3 of the Financial Courts Code.

    Article 5


    I. - Article L. 165-1 of the Social Security Code is supplemented by a paragraph to read as follows:
    "The commission prepares an annual report of activity that is submitted to Parliament. »
    II. - Article L. 5123-3 of the Public Health Code is supplemented by a paragraph to read:
    "The commission prepares an annual report of activity that is submitted to Parliament. »

    Article 6


    The Government will file, by 15 October 2003, a report presenting the financial impact of compensation for asbestos victims for the current year and the next twenty years.

    Article 7


    The Government transmits annually to Parliament, by 15 October, a report analyzing the evolution of health care funded under the national health insurance spending target.

    Article 8


    The Government transmits to Parliament, by 1 September 2003, a report on the cost of managing relations between the State and social security and proposing reforms in this regard.

    Article 9


    Every five years, before October 15, the Government transmits to Parliament a report presenting a financial statement and assessment of the schemes affecting the social contribution base, with the aim of enumerating the losses of revenue for the State and social security resulting from these schemes.

  • PART III: PROVISIONS RELATING TO RESOURCES Article 10


    I. - At 1° of Article L. 131-10 of the Social Security Code, the percentage: "90.77 %" is replaced by the percentage: "84.45 %".
    II. - In the seventh paragraph of Article L. 241-2 of the same code, the percentage: "8.84 %" is replaced by the percentage: "15.20 %".
    III. - In the second sentence of the first paragraph of Article 41 of the Social Security Financing Act, 1999 (No. 98-1194 of 23 December 1998), the percentage: "0.39 %" is replaced by the percentage: "0.35 %".
    IV. - The provisions of this section apply to amounts receivable effective January 1, 2003.

    Article 11


    I. - The general tax code is amended as follows:
    A. - In section 572, the second paragraph is deleted.
    B. - In article 572 bis, the words: "for the products of a brand taken up" are replaced by the word "replaced".
    C. - Section 575 is amended as follows:
    1° In the first paragraph, after the words: "of continental France", the words are inserted: "and the tobacco that are imported into it";
    2° The second paragraph is supplemented by a sentence as follows:
    "The amount of consumer law applicable to these cigarettes cannot be less than EUR 60 per 1,000 units and, as of July 1, 2006, to EUR 64 per 1,000 units. » ;
    3° In the sixth preambular paragraph, after the words “of the right of consumption”, the words “applicable to cigarettes referred to in the previous paragraph”.
    D. - Section 575 A is amended as follows:
    1° The second preambular paragraph reads as follows:
    "The minimum perception referred to in section 575 is set at EUR 106 for cigarettes. » ;
    2° In the third paragraph, the sum: "45 EUR" is replaced by the sum: "56 EUR";
    3° In the same paragraph, the words "and other smoking tobacco" are replaced by the words ", at EUR 45 for other smoking tobaccos";
    4° The fourth paragraph is deleted.
    E. - Section 575 C is amended as follows:
    1° The first paragraph is supplemented by the words: "or when importing";
    2° The fifth preambular paragraph reads as follows:
    "On importation, the right is due by the importer; it is recovered as in customs. »
    II. - A. - Article L. 3511-1 of the Public Health Code is supplemented by a paragraph to read as follows:
    "A substance or component other than the leaves and other natural or unprocessed parts of the tobacco plant shall be considered as an ingredient used in the manufacture or preparation of a tobacco product and still present in the finished product, even in a modified form, including paper, filter, inks and glues. »
    B. - 1. The first paragraph of article L. 3511-6 of the same code is as follows:
    "The maximum grades in tar, nicotine and carbon monoxide of cigarettes are fixed by a Minister's Health Order. »
    2. The second paragraph of the same article is deleted.
    3. In the fifth paragraph of the same article, the words "and nicotine" are replaced by the words ", nicotine and carbon monoxide".
    4. In the penultimate paragraph of the same article, the words "in nicotine and" are deleted and, after the words "in tar", are inserted the words ", in nicotine and in carbon monoxide".
    5. In the last paragraph of the same article, after the word "message", the words "general and a message" are inserted.
    C. - The same article is supplemented by a sub-item:
    "As of September 30, 2003, it is prohibited to use, on the packaging of tobacco products, texts, denominations, marks and figurative or other signs indicating that a particular tobacco product is less harmful than others. »
    III. - The provisions of I come into force on 6 January 2003.

    Article 12


    Effective January 1, 2003, the portion referred to in Article L. 131-10 of the Social Security Code is 44.77%.

    Article 13


    I. - After the article L. 245-12 of the Social Security Code, it is inserted a section 3 bis entitled "Cotisation on strong beers", including articles L. 245-13 to L. 245-13-6 as follows:
    "Art. L. 245-13. - For the benefit of the Caisse Nationale de l'assurance maladie des travailleurs wages, there is a levy on strong beers because of the risks associated with the unmodified use of these products for health.
    "Art. L. 245-13-1. - For the purposes of Article L. 245-13, the products subject to the specific right referred to in paragraph I of Article 520 A of the General Tax Code are considered beers.
    "Art. L. 245-13-2. - The contribution is due to the delivery to consumers of beer with an alcohol content greater than 8.5% vol.
    "The contribution is paid on behalf of consumers by registered depositaries, registered operators, unregistered operators and tax representatives of registered depositaries and operators established in another EU Member State, respectively mentioned in Articles 302 G, 302 H, 302 I and 302 V of the General Tax Code, which deliver these beers directly to retailers or consumers. The persons mentioned in the 2nd and 4th of 2nd of the I of Article 302 D of the said Code are also liable for the assessment.
    "Art. L. 245-13-3. - The amount of the contribution is set at EUR 200 per hectolitre.
    "Art. L. 245-13-4. - The contribution is recovered and controlled under the same rules, conditions, guarantees and sanctions as with respect to indirect contributions.
    "Art. L. 245-13-5. - The contribution is not deductible for the establishment of income tax or, if any, of the corporation tax due by the consumer.
    "Art. L. 245-13-6. - A decree sets the conditions for the application of this section. »
    II. - The provisions of I come into force on 1 January 2003.

    Article 14


    I. - Order No. 96-50 of 24 January 1996 on the reimbursement of social debt is amended as follows:
    1° In Article 2, the words "III and IV of the same article" are replaced by the words "III, IV and V of the same article";
    2° Section 4 is supplemented by a V as follows:
    "V. - The caisse pays on April 1, 2003 the sum of EUR 1,096,996,089.92 to the Central Agency for Social Security Organizations for the benefit of the National Health Insurance Fund for Employees, the National Family Allowance Fund and the National Pension Insurance Fund for Employees.
    "It shall pay at the same date, in respect of the debt relating to the exemptions of contributions listed in the 1st of Article L. 131-9 of the Social Security Code recognized in the accounts of each plan for the year 2000, the sum of 171,465,344.88 EUR to the Central Fund of the Agricultural Social Community, the sum of 10,484,547.75 EUR to the National Pension Fund »
    II. - Is accounted for at the Central Agency for Social Security Organizations in the 2003 fiscal year for exemptions from contributions listed in 1° of Article L. 131-9 of the Social Security Code, the sum of 1,096,996,089.92 EUR deducting amounts recorded in the accounts of provisions as at 31 December 2001. The central agency distributes this amount between the National Health Insurance Fund for Employees, the National Family Allowance Fund and the National Old Age Insurance Fund for Employees on the basis of claims on exemptions of contributions recorded in the accounts of each branch.

    Article 15


    I. - Article L. 245-2 of the Social Security Code is as follows:
    "Art. L. 245-2. - I. - The contribution shall be based on the accrued expenses in the last financial year in respect of:
    « 1° Compensation of all kinds, including wage savings and related social and tax expenses, persons referred to in the first paragraph of Article L. 5122-11 of the Public Health Code, whether or not they are employed by the company and whether they intervene in Metropolitan France or overseas departments with health professionals governed by the provisions of Part I of Book I Only the remuneration for the operation of the pharmaceutical specialties on the list referred to in the first paragraph of Article L. 162-17 of this Code or on the list referred to in Article L. 5123-2 of the Public Health Code;
    « 2° Reimbursements of transportation costs, excluding charges relating to vehicles made available, meals and accommodation expenses of persons mentioned in 1°;
    « 3° Publication fees and purchases of advertising space, with the exception of the medical press with a parity commission number or an approval defined under the conditions set by decree, provided that a pharmaceutical specialty listed in the list referred to in the first paragraph of Article L. 162-17 of this Code or on the list referred to in Article L. 5123-2 of the Public Health Code is mentioned therein.
    “II. - It is done on the plate defined in I:
    « 1° Has a lump sum equal to EUR 500,000 and a 3% decrease in expenses mentioned in 1° of I;
    « 2° A slaughter of an amount equal to 30% of the non-tax revenue in metropolitan France and overseas departments for the generic specialties defined in Article L. 5121-1 of the Public Health Code and the specialties refunded on the basis of a tariff determined under Article L. 162-16 of this Code, with an authorization to place on the market and entered on the list first paragraph-2.
    « 3° A slaughter of an amount equal to 30% of the non-tax revenue made in metropolitan France and overseas departments for orphan drugs designated as such pursuant to the provisions of Regulation (EC) No 141/2000 of the European Parliament and of the Council, of 16 December 1999, concerning orphan drugs, benefiting from a marketing authorization and registered on the list referred to in the first paragraph-17 of this article.
    "III. - The rate of contribution due by each company is calculated according to a scale comprising four tranches that are based on the report, under the last fiscal year ended, between, on the one hand, the plate defined in I and taking into account, if any, the cuts provided in the II and, on the other hand, the turnover of non-tax made in metropolitan France and in the overseas departments, in respect of the listed medicines
    "For each part of the plate corresponding to one of the four slices defined below, the applicable rate is as follows:


    You can see the table in the OJ
    n° of 24/12/2002 page 21482 to 21500



    II. - Article L. 245-4 of the same code is as follows:
    "Art. L. 245-4. - Are exempt from this contribution companies whose non-tax turnover realized in the last fiscal year is less than 15 million euros, except where they are subsidiaries of at least 50% of a company or group whose consolidated turnover, realized in metropolitan France or overseas departments, exceeds this limit or when they have at least 50% of the consolidated turnover of The above threshold is revalued according to economic conditions by ministerial order. »
    III. - Article L. 138-11 of the same code is read as follows:
    "(c) A maximum of 30% on the charges referred to in I of Article L. 245-2, after deduction, if any, of the deductions provided for in II of the same article, as set out by all companies in arrears. »
    IV. - The provisions of this section apply for the first time to the determination of contributions due no later than 1 December 2003.

    Article 16


    I. - Section 2 of Chapter V of Title IV of Book II of the Social Security Code is repealed.
    II. - The provisions of I come into force on 1 January 2003.

    Article 17


    For the calculation of the contribution due under the year 2003 pursuant to the first paragraph of Article L. 138-10 of the Social Security Code, the rate of 4% is substituted at the K rate mentioned in the table in the second paragraph of the same article.

    Article 18


    I. - The 3rd of Article L. 380-3 of the Social Security Code is repealed.
    II. - After article L. 380-3 of the same code, an article L. 380-3-1 is inserted as follows:
    "Art. L. 380-3-1. - I. - Border workers residing in France and subject obligatoryly to Swiss social security legislation under the provisions of the agreement of 21 June 1999 between the European Community and its Member States, on the one hand, and the Swiss Confederation, on the other hand, on the free movement of persons, but who, on their request, are exempted from compulsory affiliation to the Swiss health insurance regime in accordance with the provisions derogatory of this agreement,
    “II. - However, the border workers occupied in Switzerland and exempted from compulsory affiliation with the Swiss health insurance plan may request that the provisions of the I be not applied to them, as well as to their beneficiaries, for a transitional period ending no later than seven years after the date of entry into force of the agreement of June 21, 1999 referred to above, provided that they are able to produce a health insurance contract covering them, as well as their rights having
    "These provisions are not applicable to border workers, as well as to their right-holders, affiliated to the general regime on the date of entry into force of the agreement of June 21, 1999 referred to above, under the provisions of section 19, I, of Act No. 99-641 of July 27, 1999, establishing universal health coverage.
    "Workers who have made such a request may subsequently waive it at any time, for themselves and for their beneficiaries indistinctly, and are, from the date of this waiver, affiliated to the general regime under the provisions of I.

    "III. - The provisions of I and II are also applicable to Swiss pension or pension holders, as well as to their right holders, residing in France and subject to the Swiss social security legislation as required under the provisions of the above-mentioned agreement of 21 June 1999, but which on their application are exempt from compulsory affiliation with the Swiss health insurance scheme in accordance with the derogatory provisions of this agreement.
    "IV. - Border workers and pension and pension holders affiliated to the general plan under the conditions set out in I are not subject to contributions under section L. 136-1 and section 14 of Order No. 96-50 of 24 January 1996 relating to the reimbursement of social debt and are not liable for contributions referred to in the second paragraph of section L. 131-7-1 and section L. 380-2.
    "They are liable for a contribution set as a percentage of the amount of their income defined under the terms set out in Article 1417 of the General Tax Code. An Order in Council determines the rate and method of calculating this assessment and the reporting obligations of the subject.
    "The contribution shall be recovered according to the provisions of sections 2 to 4 of chapter III and chapter IV of title IV of Book II of this Code, subject to the modifications provided by decree in the Council of State. »
    III. - The provisions of section 18 of Act No. 99-641 of 27 July 1999 on the creation of universal health coverage are applicable to health insurance contracts that are valid when the general plan is registered under the conditions set out in I.

    Article 19


    I. - The social security code is amended as follows:
    1° In the first paragraph of Article L. 161-1, after the words: "who make the request beforehand", are inserted the words: "and benefit from the help of the creation or resumption of business established by the said article";
    2° In the first paragraph of Article L. 161-1-1, after the words "of the Labour Code" are inserted the words "that benefit from the help of the creation or resumption of business established by the said Article".
    II. - Subject to judicial decisions taken in force of action, the provisions of this article shall apply to 1 January 2002.

    Rule 20


    For 2003, the revenue projections, by category, of all mandatory basic plans and organizations created to contribute to their funding are as follows:


    You can see the table in the OJ
    n° of 24/12/2002 page 21482 to 21500

    Article 21


    For 2002, the revised revenue estimates, by category, of all core mandatory plans and organizations created to contribute to their funding are as follows:


    You can see the table in the OJ
    n° of 24/12/2002 page 21482 to 21500

  • PART IV: MALADIAN ASSURANCE PROVISIONS Article 22 Learn more about this article...


    I. - Article L. 162-22-2 of the Social Security Code is amended as follows:
    1° The first paragraph of I is as follows:
    "Every year, a national quantified objective of the institutions referred to in Article L. 6114-3 of the Public Health Code is defined as the annual amount of the expenses for hospitalization expenses for the care provided in these institutions during the year and supported by the mandatory health insurance plans. However, in this amount, the costs associated with alternating activities to central dialysis and home hospitalization are not included. The content of this national quantified objective is specified by decree. » ;
    2° I is supplemented by a sub-item:
    "This amount also takes into account developments following which institutions previously governed by section L. 6114-3 of the Public Health Code are placed, taking into account their actual activity, under the funding regime provided for in section L. 314-3 of the Code of Social Action and Families. » ;
    3° The second sentence of II is as follows:
    "It takes into account, in particular, the changes in the care expenses of the previous year and the changes in the legal and financial regimes of certain institutions. »
    II. - Article L. 162-22-3 of the same code is amended as follows:
    1° The first two sub-items of II are thus drafted:
    "The ministers responsible for health and social security and the most representative national organizations of the institutions signatories to the agreement mentioned in I observe the evolution of the loads entering the field of the national quantified objective, at least once in the year, in view of the results of the first four months of the year.
    "Each year, no later than 30 January, the National Health Insurance Fund of employed workers communicates to the State and regional health care agencies referred to in Article L. 6115-2 of the Public Health Code, for all compulsory health insurance schemes, the total amount of the expenses referred to in Article L. 162-22-2 and its distribution by region, institution and nature of activity. » ;
    2° In the third paragraph of the second paragraph, the words: "the amount of hospitalization expenses defined in the I of Article L. 162-22-2 and its distribution by region:" are replaced by the words: "the amount of expenses defined in the I of Article L. 162-22-2 and its distribution by region, no later than 31 August, for the first four months. » ;
    3° In the sixth paragraph of the second paragraph, the words "expenditures" are replaced by the words "expenditures";

    4° The 1° and 2° of the II are repealed;
    5° The III is thus written:
    "III. - The decree provided for in Article L. 162-22-2 sets out the modalities for statistical monitoring of expenses incurred by compulsory health insurance schemes, including in the event of failure by the National Health Insurance Fund to transmit the data mentioned in the preceding paragraphs within the time limits provided for in the same paragraphs. »
    III. - The fourth paragraph of article L. 162-22-8 of the same code is as follows:
    "The distribution of the amounts paid to health facilities referred to in Article L. 6114-3 of the Public Health Code under the preceding paragraph between the various mandatory health insurance schemes is carried out annually on the prorated basis of the costs of hospitalization for the care provided in these institutions the previous year and borne by each of these regimes under conditions determined by decree in the Council of State. »
    IV. - The third paragraph of Article L. 314-3 of the Code of Social Action and Families is supplemented by a sentence as follows:
    "It takes into account the developments following which institutions previously governed by section L. 6114-3 of the Public Health Code are placed, taking into account their actual activity, under the funding regime provided for in this section. »

    Article 23 Learn more about this article...


    I. - The third of section 40 of the Social Security Financing Act, 2001 (No. 2000-1257 of 23 December 2000) is supplemented by a phrase and two sentences as follows: "as well as a mission of hospital expertise and audits placed with ministers responsible for health and social security, responsible for conducting or conducting audits of the management and organization of all health facilities These references and recommendations for hospital management are communicated to the regional hospitalization agencies referred to in Article L. 6115-1 of the Public Health Code for consideration in the development of multi-year contracts of objectives and means provided for in Article L. 6114-1 of the Code. The Fund for the Modernization of Public and Private Health Institutions is also responsible for the operating costs of a mission to conduct the experiments referred to in section L. 6122-19 of the Public Health Code and a national investment support mission, located with the Minister responsible for health, as well as the operating costs of regional or interregional investment support missions placed with the regional or agency directors concerned.
    II. - The end of the last paragraph of section 1 of Act No. 78-753 of 17 July 1978 on various measures to improve the relations between the administration and the public and various provisions of an administrative, social and fiscal order, after the words: "Ombudsperson of the Republic", is thus written: ", the documents before the preparation of the report of accreditation of the health institutions referred to in Article L. 6113-6 of the Code of Health

    Article 24


    Subject to the rulings of the justice system, the overall terms of reference for the compensation of the guards carried out by the internals or acting as an intern in medicine in public health institutions for the years 1998 to 2001, are validated as their regularity is questioned on the basis of taking into account a compensation rate corresponding to that of hospital practitioners.

    Rule 25


    I. - In the first paragraph of Article L. 6122-19 of the Public Health Code, the words: "based on a tariff to pathology" are replaced by the words: "based on their activities and established according to the information they collect and transmit pursuant to Articles L. 6113-7 and L. 6113-8 of this Code and of Article L. 162-22-1 of the Social Security Code".
    II. - The Government shall transmit annually to Parliament, by 15 October, a study report on the implementation of the tariff to the activity of care facilities.

    Rule 26 Learn more about this article...


    I. - The obligations and claims of the Fund for the Modernization of Private Clinics established by section 33 of the Social Security Financing Act for 2000 (No. 99-1140 of 29 December 1999) are transferred from 1 January 2003 to the Fund for the Modernization of Health Institutions established by section 40 of the Social Security Financing Act for 2001 (No. 2000-1257 of 23 December 2000).
    II. - The available balance of the Private Clinic Modernization Fund as at 31 December 2002 is paid to the Health Modernization Fund. The amount of the balance is determined by decree of ministers responsible for social security and budget.
    III. - The amount of grants from the Fund for the Modernization of Private Clinics allocated to private health institutions referred to in Article L. 6114-3 of the Public Health Code for the financing of social and salary shares is taken into account for the determination and monitoring of the national quantified objective referred to in Article L. 162-22-2 of the Social Security Code for 2003.
    The rates for the benefit of the recipient institutions of these grants are revalued, as of January 1, 2003, within the limits of the amounts allocated.
    IV. - As of January 1, 2003, the VIII of section 33 of the Social Security Financing Act for 2000 referred to above is repealed and, in the I of section 40 of the Social Security Financing Act for 2001 referred to above, after the words: "fund for the modernization of health facilities" are inserted the words "public and private".
    V. - In article L. 6161-9 of the Public Health Code, the words: "Fund for the Modernization of Private Clinics" are replaced by the words: "Fund for the Modernization of Public and Private Health Institutions".
    VI. - The amount of participation of compulsory health insurance plans in the Fund for the Modernization of Public and Private Health Institutions is set, for the year 2003, to € 450 million.
    VII. - Article 40 of the Social Security Funding Act, 2001 is supplemented by an VIII, which reads as follows:
    « VIII. - An annual report on the activity of the fund is prepared by the Caisse des dépôts et consignations and sent to the ministers responsible for health and social security. This report includes an assessment of the allocation of allocations based on the status and size of recipient institutions. »

    Rule 27 Learn more about this article...


    Section 14 of Act No. 94-628 of 25 July 1994 on the organization of work time, recruitment and transfer in the public service is thus amended:

    1° Its current provisions constitute an I;
    2° At the end of the last paragraph, the word "article" is replaced by the word "I";
    3° It is complemented by a II written as follows:
    “II. - The hospital employment fund also contributes, under the conditions set by decree, to the financing of the leave entitlements acquired under the reduction of the working time not taken or carried into a time savings account due to the progressive realization of the recruitments. In this capacity, only the fees acquired in 2002, 2003 and 2004 by the doctors, pharmacists and odontologists mentioned in the 1st and last paragraphs of section L. 6152-1 of the Public Health Code and in 2002 and 2003 by the officers of the institutions referred to in section 2 of Act No. 86-33 of 9 January 1986 bearing statutory provisions relating to the public hospital service and subject to the other remuneration of the insurance and
    "A decree of the Ministers responsible for health and social security shall, each year, set the amount of the appropriation in the accounts of the fund.
    "The operations of the fund carried out for the exercise of this mission are subject to separate monitoring in accounting.
    "The mandatory health insurance plans provide the fund for the exercise of this mission to the level of the amount of the appropriations that are approved annually under the interdepartmental order referred to in the second paragraph of this II. The distribution between the different regimes is carried out under the conditions defined by Article L. 174-2 of the Social Security Code. »

    Rule 28


    [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]

    Rule 29


    I. - Article L. 162-5-9 of the Social Security Code is amended as follows:
    1° The III is thus written:
    "III. - The provisions of this Article shall apply to each of the health professions referred to in Article L. 162-1-13, after consultation with the National Health Insurance Fund for Employees and, for each profession, representative trade union organizations and, as appropriate, the organization in charge of the ethical matters of that profession. » ;
    2° The IV is supplemented by a sentence as follows:
    "This regulation sets out the fees, remuneration and incidental fees paid by social insurance workers to the professionals concerned outside of cases of authorized overtaking. »
    II. - Sub-section 2 of section 3-1 of chapter II of title VI of Book I of the same code is repealed.
    III. - In article L. 162-5-13 of the same code, the words "in article L. 162-15-2" are replaced by the words "in articles L. 162-14-2 and L. 162-5-9".

    IV. - In article L. 162-45 of the same code, the words ", L. 162-14, L. 162-15-2 and L. 162-15-3" are replaced by the words "and L. 162-14".
    V. - In Article L. 162-15 of the same code, the words: " Subject to the provisions of Article L. 162-15-3 shall be deleted.
    VI. - In section L. 322-5-1 of the same code, the reference: "L. 162-15-2" is replaced by the reference: "L. 162-5-9".
    VII. - Article L. 162-12-16 of the same code is amended as follows:
    1° The third paragraph is deleted;
    2° In the fourth paragraph, the words "or, if not, by the regional medical committee referred to in Article L. 315-3" are deleted.
    VIII. - Section L. 315-3 of the same code is repealed.
    IX. - In the third paragraph of Article L. 615-13 of the same code, the words ", L. 315-2-1 and L. 315-3" are replaced by the words "and L. 315-2-1".
    X. - In the first paragraph of Article L. 732-5 of the Rural Code, the words "and L. 315-3" are replaced by the words "and L. 315-2-1".

    Rule 30


    [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]

    Rule 31


    When the Minister approves or approves the agreements, conventions, annexes and amendments referred to in articles L. 162-1-13, L. 162-14-1 and L. 162-14-2 of the Social Security Code, the Minister responsible for Social Security shall send a report to the competent committees of Parliament on the coherence of these agreements, conventions, annexes and amendments with the objective set out in 4° of I of Article LO 111-3 of that Code.
    [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]

    Rule 32


    [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]

    Rule 33


    Article L. 162-5 of the Social Security Code is supplemented by a 15° as follows:
    « 15° Measures and procedures for physicians whose abusive practices are contrary to the objectives of good practices and good use of care set out in the Convention. »

    Rule 34


    I. - In the last sentence of the first paragraph of Article L. 162-17-4 of the Social Security Code, the words: "These conventions determine the relations between the committee and each company" are replaced by the words: "These conventions, the framework of which can be specified by an agreement with one or more representative unions of the companies concerned, determine the relations between the committee and each company".
    II. - The first sentence of the penultimate paragraph of Article L. 138-10 of the same code is supplemented by the words: "and that this agreement is in addition in accordance with the terms defined by an agreement entered into under the first paragraph of Article L. 162-17-4, subject to the conclusion of such agreement".

    Rule 35


    I. - In the III of Article 36 of the Social Security Financing Act for 2002 (No. 2001-1246 of 21 December 2001), the words: ", for the duration fixed by the approval" are replaced by the words: "to 31 December 2004".
    II. - The provisions of the financing agreements concluded between the registered networks pursuant to Article L. 162-31-1 of the Social Security Code in its drafting pursuant to Article 6 of Order No. 96-345 of 24 April 1996 relating to the medical control of care expenses and health insurance organizations may, by avender, be extended until 31 December 2004.

    Rule 36


    After article L. 162-17-5 of the Social Security Code, an article L. 162-17-6 is inserted as follows:
    "Art. L. 162-17-6. - The company that operates a drug may, when this drug presents, by improving the medical service rendered, a particular interest in public health, request an accelerated registration procedure on the list referred to in the first paragraph of section L. 162-17.
    "An agreement entered into pursuant to the first paragraph of Article L. 162-17-4 or, if not, a decree in the Council of State specifies the drugs to which this procedure is applicable, the modalities of implementation and the nature of the commitments to be made by the company. »

    Rule 37 Learn more about this article...


    I. - The eighth and ninth paragraphs of Article L. 162-17-4 of the Social Security Code are replaced by five paragraphs as follows:
    "When an advertising ban was imposed by the French Health Products Agency under the conditions set out in Article L. 5122-9 of the Public Health Code, the Ministers responsible for health and social security may, after the opinion of the Economic Committee for Health Products and after the company has been put in a position to submit its observations, a financial penalty against the said undertaking.
    "This penalty cannot be more than 10% of the non-tax sales made in France by the company in respect of the specialties that have been the subject of advertising prohibited during the six months preceding and six months after the ban date.
    "Its amount is determined on the basis of the gravity of the offence sanctioned by the ban measure and the evolution of the sales of the specialties concerned during the period defined in the preceding paragraph.
    "The penalty is recovered by the Central Agency of Social Security Agencies. Its product is assigned to health insurance plans according to the rules set out in section L. 138-8 of this code.
    "The appeal against the decision making this penalty is a full jurisdiction appeal. »
    II. - After article L. 162-17-5 of the same code, an article L. 162-17-7 is inserted as follows:
    "Art. L. 162-17-7. - If it turns out, after the registration of a drug on the list referred to in the first paragraph of the article L. 162-17, that the company that operates the drug did not provide, by signaling the scope, information known to it before or after the registration and that this information leads to change the evaluations carried by the commission referred to in article L. 5123-3 of the
    "The amount of the penalty cannot be more than 5% of the total revenue excluding taxes realized in France by the company during the last fiscal year ended.
    "The modalities for the application of this article, including the nature of the information concerned, the rules and time limits of procedure, the methods of calculating the financial penalty and the distribution of its product among social security organizations, are determined by decree in the Council of State.
    "The penalty is recovered by the Central Agency of Social Security Agencies. Its product is assigned to health insurance plans according to the rules set out in section L. 138-8 of this code.

    "The appeal against the decision making this penalty is a full jurisdiction appeal. »

    Rule 38 Learn more about this article...


    I. - After the fifth paragraph of Article L. 314-8 of the Code of Social Action and Families, it is inserted a paragraph as follows:
    "The medico-social expenses of the specialized care centers for drug addicts under the categories of establishments referred to in 9° of I of Article L. 312-1 shall be borne by health insurance without prejudice to other participations, including local authorities, and without the application of the provisions of the social security code and the rural code relating to the opening of the right to benefits covered by the basic health insurance plans, to the reimbursement »
    II. - The first paragraph of Article L. 3411-2 of the Public Health Code is supplemented by the words: ", excluding the expenses mentioned in the sixth paragraph of Article L. 314-8 of the Code of Social Action and Families".
    III. - Section 3 of Chapter IV of Title VII of Book I of the Social Security Code is supplemented by an article L. 174-9-1, as follows:
    "Art. L. 174-9-1. - The specialized care centres for drug addicts referred to in Article L. 314-8 of the Social Action Code and families are funded in the form of an annual global endowment.
    "The distribution of the amounts paid to these centres under the preceding paragraph between the health insurance plans is carried out each year following the apportionment of the expenses of the overall hospital endowments for the year under review as a result of the application of section L. 174-2. »
    IV. - After the fourth paragraph of Article L. 313-1 of the Code of Social Action and Families, it is inserted a paragraph as follows:
    "As a transitional measure, the first authorization issued to specialized care centres for drug addicts in accordance with the provisions of this article shall last three years. »
    V. - The management bodies of specialized care centres for drug addicts who have entered into agreements with the prefect of the department where they are established on the date of publication of this Act shall, from that same date, have a period of one year to apply for the authorization referred to in Article L. 313-1 of the Code of Social Action and Families and in accordance with the procedure established by Article L. 313-2 of that Code. The agreement becomes null and void if this authorization has not been sought after the expiry of this period.
    VI. - Waiting for the order setting the overall staffing for the year 2003, the health insurance funds pay to each specialized care centre to the drug addicts previously funded by the State monthly payments on the overall funding allocation, equal to the twelfth of the State's participation allocated to each centre for its medico-social activities in 2002, deducting, if any, from the funding of local authorities. Any refusal to authorize a centre ends its funding through health insurance.

    Rule 39 Learn more about this article...


    Chapter II of Title III of Book I of the Social Security Code is thus amended:
    1° The title of the chapter is as follows: "Insurance by health insurance of expenses related to voluntary interruptions of pregnancy referred to in the third paragraph of Article L. 2212-7 of the Public Health Code";
    2° The first paragraph of Article L. 132-1 is deleted;
    3° In the second paragraph of Article L. 132-1, the words "State" are replaced by the words "health insurance organizations".

    Rule 40 Learn more about this article...


    I. - Title II of Book III of Part VI of the Public Health Code is supplemented by a chapter V as follows:


    “Chapter V
    “Permanence of care


    "Art. L. 6325-1. - Subject to the missions to health institutions, the doctors mentioned in article L. 162-5, within the framework of their liberal activity, and in article L. 162-32-1 of the Social Security Code, participate, for the purpose of general interest, in the permanence of care in conditions and in the manner of organisation defined by a decree in the Council of State. »
    II. - Article L. 162-5 of the Social Security Code is supplemented by a 16° as follows:
    « 16° Methods of compensation by health insurance, if any other than payment to the deed, of the participation of physicians in the care permanence device pursuant to the provisions of Article L. 6325-1 of the Public Health Code. »

    Rule 41 Learn more about this article...


    I. - Article L. 6312-5 of the Public Health Code is supplemented by a paragraph to read as follows:
    " - the conditions in which the representative of the State in the department organizes, after advice of the committee mentioned in article L. 6313-1, the departmental guard ensuring the permanence of the health transport. »
    II. - Article L. 322-5-2 of the Social Security Code is supplemented by a 6° as follows:
    « 6° The conditions of pay of sanitary transport companies for their participation in the departmental guard organized under the conditions provided for in the last paragraph of Article L. 6312-5 of the Public Health Code. »

    III. - The first sentence of article L. 161-34 of the same code is as follows:
    "For the professions affected by the provisions of Chapters II and V of this Title and by the provisions of Articles L. 322-5 to L. 322-5-4, the national conventions, national agreements and contracts or the provisions applicable in the absence of a convention, contract or agreement shall specify, for each profession or institution concerned and in addition to the provisions of Article L. 161-33, the modalities for the electronic transmission of the documents necessary for the refund or the »

    Rule 42


    I. - At the I of Article L. 313-12 of the Code of Social Action and Families, the date: "31 December 2003" is replaced by the words: "31 December 2005, or before 31 December 2006 for establishments referred to in Article L. 633-1 of the Construction and Housing Code".
    II. - In the first paragraph of Article 5 of Act No. 2001-647 of 20 July 2001 on the care for the loss of autonomy of older persons and the personalized allowance of autonomy, the words: "at the latest until 31 December 2003" are replaced by the words: "at the latest until the date mentioned in Article L. 313-12 of the same code".

    Rule 43 Learn more about this article...


    I. - Article L. 162-16 of the Social Security Code is amended as follows:
    1° After the words: "Public Health Code", the end of the second paragraph is as follows: "The issue of this specialty should not result in an additional expenditure for health insurance higher than the expenditure that would result in the issuance of the most expensive generic specialty of the same group";
    2° After the words: "above", the end of the third paragraph is thus written: "the expenditure that would result in the issuance of the most expensive generic specialty of the same group";
    3° After the first paragraph, three subparagraphs are inserted:
    "For drugs in a generic group provided for at the 5th of Article L. 5121-1 of the Public Health Code, the basis for reimbursement of expenses incurred by insured persons may be limited to a flat rate of liability established by the Ministers of Health and Social Security after notice of the Economic Committee for Health Products established by Article L. 162-17-3 of this Code.
    "When the flat rate applies, the ceiling referred to in section L. 138-9 is set at 2.5% of the drug price.
    "The provisions of the fifth paragraph of this section do not apply to drugs refunded on the basis of a flat rate. » ;
    4° The fourth preambular paragraph reads as follows:
    "In the event of non-compliance with the provisions of the fifth and sixth preambular paragraphs, the pharmacist shall pay to the care organization, after it has been put in a position to submit its written comments and if, after receiving them, the pharmacist maintains the request, an amount corresponding to the additional expenditure referred to in the fifth and sixth preambular paragraphs, which may not be less than a lump sum determined by the agreement provided for in Article L 162-16. Otherwise, this amount is determined by the ministers responsible for social security, health, economy and budget. »
    II. - The Public Health Code is amended as follows:
    1° Before the last sentence of the sixth paragraph (5°) of Article L. 5121-1, it is inserted a sentence as follows:
    "In the absence of a reference specialty, a generic group may be made up of specialties with the same qualitative and quantitative composition in active principle, the same pharmaceutical form and whose safety and efficiency profile is equivalent. » ;
    2° The second paragraph (1°) of Article L. 5121-20 is supplemented by the words: "and the modalities for the creation of generic groups in the absence of a reference specialty, as these groups are defined at 5° of Article L. 5121-1".

    Rule 44


    When the flat rate applies, and by derogation from the third paragraph of section L. 162-16 of the Social Security Code, the ceiling of the discounts provided for in the first paragraph of section L. 138-9 of that code is set at 6% of the selling price for all specialties subject to a refund package. This provision applies until June 30, 2004.

    Rule 45 Learn more about this article...


    Article 4 of Act No. 88-16 of 5 January 1988 on social security is amended as follows:
    1° In the first paragraph of I, the date: "December 31, 2004" is replaced by the words: "October 1, 2003, with exceptions defined by decree";
    2° The fifth paragraph of I is deleted;
    3° In the third paragraph of I, the words "by the convention or decree mentioned" are replaced by the words "by the decree mentioned";
    4° The eighth preambular paragraph is read as follows:
    "The allowance can only be accumulated with the income of an employee medical activity within the limits of a ceiling set by the decree mentioned in III."
    5° The ninth and tenth paragraphs of I are deleted;
    6° II is supplemented by a sub-item:
    "The balance, as of December 31, of each year, of cash contributions and benefits served during the fiscal year is allocated to the funding of additional old-age benefits to physicians under section L. 645-1 of the Social Security Code. » ;
    7° The III is thus written:
    "III. - The amount of the allowance, the amount of the contribution and the distribution of the contribution between doctors and health insurance plans and the cases of exemption are fixed by decree. The decree also sets out the cases and conditions in which, on an exceptional basis, the date referred to in the first paragraph of I may be fixed after 1 October 2003 for persons who organized their cessation of activity before 1 October 2002. »

    Rule 46


    I. - After the eighth paragraph of Article L. 161-22 of the Social Security Code, it is inserted a 7° as follows:
    « 7° Activities related to vacations in health facilities or social and medico-social facilities or services and at their request by retired doctors or nurses, within the limits of a duration and a ceiling provided by decree in the Council of State. The overexpenditure of the ceiling results in a loss of pension. This opportunity to accumulate is only open from the legal or regulatory age of retirement. »
    II. - In the fifth paragraph of Article L. 732-39 of the Rural Code, the words "and 5°" are replaced by the words ", 5° and 7°".
    III. - The last paragraph of Article L. 643-2 of the Social Security Code is replaced by three paragraphs:
    "The allocation of the old age allowance is conditional on the cessation of liberal activity.
    "However, for specific professional activities and after the advice of the National Insurance Fund for the Old Age of the Professionals, decrees may provide, given the number and distribution of doctors and nurses in the health and medical-social sector, the possibility to accumulate the allowance with the revenues derived from the liberal activity within the limits of a ceiling and provided that this activity has an incidental character to start with
    "The exceedance of the ceiling referred to in the previous paragraph results in a reduction in the old age allowance. »

    Rule 47


    The amount of the overall allocation for the funding of the National Office for Medical Accident Compensation, Iiatrogen Diseases and Nosocomial Infections, referred to in section L. 1142-23 of the Public Health Code, is as follows:
    1° 70 million euros for the year 2002;
    2° 70 million euros for the year 2003.

    Rule 48


    I. - Part II of Article 25 of the Social Security Financing Act, 1999 (No. 98-1194 of 23 December 1998) is supplemented by a paragraph to read:
    "The fund participates in the evaluation of the professional practices of the liberal physicians organized by the regional unions of the liberal doctors referred to in Article L. 4134-1 of the Public Health Code and the evaluation of the professional practices of the doctors exercising in the structures referred to in Article L. 6323-1 of the Public Health Code organized by the regional unions of the health insurance funds referred to in Article L. 183-1 of the Social Security Code. »
    II. - For 2003, the maximum amount of expenditure of the fund established in section 25 of the Social Security Financing Act for 1999 above is set at 106 million euros.
    This fund has 20 million euros in fiscal year 2003.

    Rule 49


    The national objective of health insurance expenditures for all basic mandatory plans is set at 123.5 billion euros for the year 2003.

    Rule 50


    For 2003, the objective of spending on the health, maternity, disability and death of all of the mandatory basic plans with more than twenty thousand active or retired contributors holding clean rights is set at EUR 136.35 billion.

    Rule 51


    The revised national health insurance expenditure target for all basic mandatory plans is €11.7 billion for the year 2002.

  • PART V: PROVISIONS RELATING TO OTHER BRANCHES OF SOCIAL SECURITY
    • Section 1: Industrial Accidents and Occupational Diseases Branch Rule 52


      I. - At 2° of Article 43 of the Social Security Financing Act for 2002 (No. 2001-1246 of 21 December 2001), the sum: "76.22 million euros" is replaced by the sum: "180 million euros".
      The amount of the contribution of the industrial accidents and occupational diseases branch of the general social security system to the financing of the Asbestos Victim Compensation Fund, referred to in the VII of Article 53 of the Social Security Financing Act for 2001 (No. 2000-1257 of 23 December 2000), is set at 190 million euros for the year 2003.
      II. - The VII of Article 53 of the Social Security Financing Act for 2001 is supplemented by the words: "every year before July 1st".

      Rule 53


      I. - In II of Article 47 of the Social Security Financing Act for 2002, the sum: "200 million euros" is replaced by the sum: "300 million euros".
      The amount of the contribution of the industrial accidents and occupational diseases branch of the general social security system to the financing of the Asbestos workers' early termination fund, referred to in the III of Article 41 of the Social Security Financing Act for 1999 (No. 98-1194 of 23 December 1998), is set at 450 million euros for the year 2003.
      II. - In the last sentence of the last paragraph of the III of Article 41 of the Social Security Financing Act for 1999 referred to above, after the word "Government" are inserted the words ", before July 15,".

      Rule 54 Learn more about this article...


      Section 41 of the Social Security Funding Act for 1999 is amended as follows:
      1° The eighth preambular paragraph is read as follows:
      "Also, at the age of fifty years, the allowance for early termination of activity is entitled to persons recognized as having, under the general regime or the insurance scheme for industrial accidents and occupational diseases of agricultural workers, an occupational illness caused by asbestos and on a list established by decrees of ministers responsible for labour, social security and agriculture. » ;
      2° The second paragraph of the second paragraph of the second paragraph is supplemented by a sentence as follows:
      "For those who are recognized as having an occupational illness, the allowance is allocated and served by the farm social mutuality funds for the workers' occupational health insurance plan and occupational diseases. » ;
      3° The III is thus amended:
      (a) After the words: "general code of taxes", the end of the first paragraph is thus written: ", a contribution of the industrial accident industry and occupational diseases of the general social security regime, the amount of which is fixed annually by the law of financing of social security and a contribution of the occupational accidents and diseases of the agricultural workers' system, the amount of which is fixed annually by decrees of the ministers responsible for social security, the budget"
      (b) In the first sentence of the second paragraph, after the words: "in article L. 221-4 of the social security code", the words are inserted: ", representatives of the central board of the administration of agricultural social mutuality referred to in article L. 723-32 of the rural code";
      4° In the second paragraph of the IV, the words: "of the general regime" are replaced by the words: "of the regime they belonged to before the cessation of activity".

      Rule 55


      I. - The amount of the payment referred to in Article L. 176-1 of the Social Security Code is set, for the year 2003, to 330 million euros.
      II. - The last paragraph of Article L. 176-1 of the same code is supplemented by the words: "before July 1 of the year under review".

      Rule 56


      The Social Security Code is thus amended:
      I. - [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]
      II. - [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]

      III. - [Dispositions declared not in conformity with the Constitution by decision of the Constitutional Council No. 2002-463 DC of 12 December 2002. ]
      IV. - In the second paragraph of Article L. 227-1, the words: "targeted at 1°, 3° and 4°" are replaced by the words: "specified at 1°, 2°, 3° and 4°".
      V. - Article L. 227-2 is supplemented by the words: "and, with regard to the convention of objectives and management relating to the occupational accident and disease industry, by the president of the Industrial Accidents and Occupational Diseases Board and by the director of the National Health Insurance Fund of Employee Workers".
      VI. - The second sentence of article L. 227-3 is as follows:
      "These multi-year management contracts are signed, on behalf of each national body, by the chair of the board of directors or, as the case may be, by the chair of the Industrial Accidents and Occupational Diseases Board and by the director and, on behalf of the regional or local body, by the chair of the board of directors and the director of the agency concerned. »
      VII. - Article L. 228-1 is amended as follows:
      1° In the first sentence of the first paragraph, after the words: "National Health Insurance Fund for Employees" are inserted the words: "on the one hand for the sickness, maternity, disability and death, on the other hand for the occupational accident and disease industry";
      2° In the second sentence of the first paragraph, the words: "The Supervisory Board established" are replaced by the words: "The Supervisory Boards established", and the words: "is compounded" are replaced by the words: "are compounded";
      3° In the third paragraph, after the words: "The president of each national body and the central agency" are inserted the words: "and the president of the commission of occupational accidents and diseases".

      Rule 57


      For 2003, the objective of expenditures of the occupational accidents and diseases industry of all the basic mandatory plans with more than twenty thousand active or retired contributors holding clean rights is set at 9.40 billion euros.

    • Section 2: Family Branch Rule 58


      I. - Article L. 521-1 of the Social Security Code is supplemented by a paragraph to read as follows:
      "A lump sum allowance per child of an amount fixed by decree shall be paid for one year to the person or household who bears the charge of a minimum number of children also fixed by decree when one or more of the children who were entitled to family allowances reach the limit age referred to in 2° of Article L. 512-3. This allowance is paid on the condition that the child(s) meets conditions other than those of the age for the opening of the right to family allowances. »
      II. - The provisions of I are applicable as of July 1, 2003 for children who reach the age limit from that date.

      Rule 59


      The share of expenses covered by the National Fund for Family Allowances referred to in 5° of Article L. 223-1 of the Social Security Code is equal to a fraction of 60% for 2003.

      Rule 60


      For 2003, the objective of spending on the family branch of all mandatory basic plans with more than twenty thousand active or retired members of the family sector holding their own rights is set at 43.62 billion euros.

    • Section 3: Old Age Branch Rule 61


      Article L. 351-11 of the Social Security Code reads as follows:
      "Art. L. 351-11. - For the year 2003, the coefficient of revalorization applicable to old-age pensions already liquidated as at 1 January and the contributions and salaries used as the basis for their calculation is 1.015. »

      Rule 62


      In the first paragraph of Article 27 of the Social Security Financing Act, 2001 (No. 2000-1257 of 23 December 2000), after the words: "The organizations cited in Article L. 161-17-1 of the Social Security Code" are inserted the words: "and the organization responsible for the unemployment insurance system".

      Rule 63


      For 2003, the objective of spending of the old-age and widowed branch of all mandatory basic plans with more than twenty thousand active or retired contributors holding clean rights is set at 140.36 billion euros.

  • PART VI: REVIEW OF EXPENDITURES FOR 2002 Rule 64


    For 2002, the revised spending targets per branch of all mandatory base plans with more than twenty thousand active or retired equity holders are set to the following amounts:


    You can see the table in the OJ
    n° of 24/12/2002 page 21482 to 21500

  • PART VII: OTHER MEASURES AND PROVISIONS Rule 65


    I. - In Title III of Book I of the Social Security Code, a chapter VIII bis is inserted entitled: "Common provisions for contributions recovered directly by the Central Agency of Social Security Organizations" and comprising four articles L. 138-20 to L. 138-23 as follows:
    "Art. L. 138-20. - Contributions established in articles L. 137-6, L. 138-1, L. 138-10 and L. 245-1 are recovered and controlled under the conditions provided for in this section by the Central Agency for Social Security Agencies. The central agency may require the assistance of unions to collect social security and family allowance contributions and general social security funds from overseas departments, in particular by the provision of agents of these organizations, in particular collectors, to ensure control actions. Authorized officers may collect from contributors any information that may permit the monitoring of the base and scope of contributions.

    "Art. L. 138-21. - The Central Agency of Social Security Organizations provides recovery operations, under the conditions set out in Article L. 225-1-1. Prior to any contentious action, any claim must give rise to a gratis appeal to the central agency.
    "The central agency may grant, where appropriate, the remission of the increases and penalties applied as well as the instalment tax applied in the event of a failure to report. The graceful request for the award of penalties and increases is admissible only after the payment of all contributions due. The reward is conditioned to the good faith of the debtor, duly proved by his care.
    "The disputes are brought before a court of law.
    "Art. L. 138-22. - Companies or groups not established in France designate a representative resident in France personally responsible for the declarative transactions and the payment of the amounts due.
    "Art. L. 138-23. - A decree in the Council of State shall, as necessary, establish the modalities for the application of the provisions of this chapter. »
    II. - Articles L. 137-8, L. 138-3 and L. 138-14 of the same code are repealed; the fourth paragraph of Article L. 137-7 and the second, third and fourth paragraphs of Article L. 245-6 of the same code are deleted.
    III. - The provisions of this article shall enter into force on 1 January 2003.

    Rule 66


    Article L. 144-2 of the Social Security Code is amended as follows:
    1° The first paragraph is as follows:
    "With the exception of the remuneration of the presidents of the courts and their secretaries as well as those of the Secretary-General and the Assistant Secretaries-General of the National Court of Disability and Costs of Insurance for Industrial Accidents, the expenses of any kind resulting from the application of chapters II and III of this title are:";
    2° In the second and third paragraphs, the words: "competent central funds for agricultural social mutuality" are replaced by the words: "the Central Fund for Agricultural Social Mutuality";
    3° After the third paragraph (2°), it is inserted a 3° as follows:
    « 3° Or refunded by the competent national body of the general regime to the state budget. » ;
    4° In the penultimate paragraph, the words: "in the preceding paragraph" are replaced by the words: "at 1°, 2° and 3°";
    5° In the last paragraph, the words: "the National Solidarity Fund provided for in Book VIII of this Code" are replaced by the words: "the special disability fund referred to in Article L. 815-3-1 and the old-age solidarity fund established by Article L. 135-1".

    Rule 67


    Forecasts, in both revenue and expenditure, of the Fund for the Reform of Corporate Social Security Contributions are set at the sum of 16,560 million euros for 2003, in accordance with Schedule f attached to the Social Security Financing Bill for 2003.

    Rule 68


    The cash requirements of mandatory base plans with more than twenty thousand active or retired contributors with their own rights and organizations whose mission is to contribute to their financing may be covered by non-permanent resources within the following limits:


    You can see the table in the OJ
    n° of 24/12/2002 page 21482 to 21500



    Other mandatory base plans with more than twenty thousand active or retired contributors with their own rights, where they have an autonomous cash pool, are not allowed to use non-permanent resources.

    This law will be enforced as a law of the State.


Annex


A N N E X E


REPORT ON THE ORIENTATIONS OF HEALTH AND SOCIAL SECURITY POLICY AND THE OBJECTIVES OF THE GENERAL CONDITIONS OF THE FINANCIAL EQUIPMENT OF SOCIAL SECURITY
Today France has a system of social security among the most generous in the world. Since 1945, it has been a pillar of our social model to which our fellow citizens are particularly attached because it is an instrument of reducing the alesas of existence and combating inequalities and exclusion. Social security policies also contribute to the economic dynamism of our country by providing the French with the living conditions that enable them to create more wealth.
Our health system is ranked by the World Health Organization among the most powerful. This is due to the high quality of nursing staff and the wide accessibility to the care enjoyed by the French. Health indicators also place us at the forefront of countries around the world: French people live on average longer than most people in other countries. Our family policy has long and successfully mobilized large resources to compensate for the cost of the child, to support our demographics and to combat social inequalities. Finally, the level of life of retirees gradually reached the level of assets.
However, our social protection system has been experiencing difficulties for several years. As the Court of Auditors points out, our health system, too exclusively curative, is faced with too many dysfunctions, whether it is too centralized, the organization and operation of the hospital, the demography of health professions, the conditions for the exercise of doctors or the prescription of medicines. Similarly, our care system, like our social security in general, suffers from some confusion of responsibilities and priorities. The material and moral crisis of health results in a feeling of discomfort among health professionals as well as unresolved tensions and conflicts.
The financial situation is not the least of the difficulties faced by health insurance and the general plan. The growth of social security benefits, including health insurance expenses, is not denying itself, both in France and abroad, despite the successive reforms that have been implemented. The accounts of the general social security system deteriorated in 2002. The overall deficit is expected to reach 3.3 billion euros, and the deficit of the sick branch is nearly 6 billion. This is certainly due to the weakness of economic growth in 2002, but especially to the fragility of the surpluses of previous years. In fact, the surpluses of the 2000s and 2001s were only obtained through an exceptional growth in the payroll mass of more than 6% each year. They were not used to undertake the necessary substantive reforms.
Several principles guide the Government ' s health and social security policy:
- dialogue and confidence: the Government wishes to take the time of listening and dialogue because social dialogue is the prerequisite for ambitious reform;
- clarification of priorities and responsibilities: the Government wishes to establish a new governance, particularly in the area of health insurance. This requires redefining the skills of all partners while entering the decentralization process;
- shared responsibility: in the field of health in particular, each actor, whether it be health professionals, health institutions, patients or manufacturers of the drug, must assume a share of responsibility in the proper functioning of the system;

- the extreme rigour in spending: this concern must lead to the measurement of expenditure in the context of solidarity and the efforts imposed on the contributors at every moment;
- excellence: the search for a maximum level of health quality and safety is, in the field of care, a professional and ethical requirement;
- transparency and sincerity: we must gradually find solutions to make our social finances clear and understandable;
- the quality of service rendered to insured persons, health professionals and businesses: it must be a constant objective of the Government's action. It involves simplification measures and a significant increase in the use of new information technologies.
These principles are reflected in each part of the health and social security policy that the Government will conduct in the coming years. The funding law for 2003 reflects philosophy and includes the first signs. The weight of the past still gives it the character of a transition text.


1. Health and health insurance policy


An ambitious public health policy, a new governance of the health and health insurance system, better access to prevention and care for users and the promotion of innovation and excellence in the care system are the guidelines of the Government's strategy.


1.1. An ambitious public health policy


Public health is a compelling duty. It is the priority of the Government ' s health policy. It is about strengthening collective action to give our fellow citizens the conditions of living in good health. This lack of determination, coherence and means to date. For example, the 2003 Finance Bill provides for a total of 284 million euros for public health activities, with high funding for cancer control, prevention and health risk management.


1.1.1. The Public Health Programming Act


The Government will propose in the spring of 2003 a five-year Public Health Programming Act in Parliament.
For more efficiency, the first objective of this law will be to clarify the role of actors. The multiplicity of actors (state, local authorities, health insurance funds, hospitals, companies, associations...) causes a complete entanglement of the skills that do not have for counterpart an abundance of means. Public health policy must first be defined at the national level, its coherence that meets a requirement of equality and is a guarantee of success. The Programming Act will also define priority public health objectives for the next five years. Specific indicators will accompany these objectives in order to enable a real control of the Government's action by Parliament and, beyond that, by the citizens themselves.
Different situations and priorities may exist from region to region. The law will therefore determine the modalities of collective choice to decline national public health priorities and regional specificities. This national policy will take into account existing territorial inequalities in public health.
The preparation of this Public Health Programming Act will be carried out through broad consultation. The Government will complete consultations in each region by the end of 2002. They will form the basis of the bill.

Finally, the Public Health Programming Act will restore ordinal institutions from the Act of 4 February 1995 on various social provisions, in particular that of the masseurs-kinésitherapists.


1.1.2. Place prevention at the heart of public health


Prevention remains underdeveloped and organized in France in relation to care efforts. This implicit choice, which favours curative rather than preventive, results unfavourablely on premature mortality (before sixty-five years) and early morbidity, even though our overall health indicators are excellent.
The Government's ambition is to promote a rebalancing of the health policy between prevention and care, with a focus on primary and secondary prevention. This requires the development in society of a true culture of prevention. The responsibility of each person must be committed to preserving their health capital.
To achieve this, specific policies will be developed on the basis of concrete issues. In particular, they will aim at all ages of life, from the youngest to the oldest. In addition, specific environments should be the subject of concerted measures (school, work, risk environments...). In addition, developed methods can focus on behaviours but also on improving living conditions. They will rely on communication, information and education, as well as on early detection and care strategies. This is to adopt a general policy that will be declined according to the different pathologies considered.


1.1.3. A special priority: cancer


Among public health priorities, the Public Health Programming Act will take into account, first of all, cancer, which is one of the three projects of the President of the Republic for the quinquennium. 700,000 people have cancer in France and, each year, 250,000 new cases of cancer are diagnosed. Cancer is the first cause of premature mortality in France and the second medical cause of death.
70% of cancers are attributable to risk factors that can be effectively addressed. The active fight against tobacco and alcohol consumption will therefore be developed. As early as 2003, tobacco rights will increase by almost 1 billion euros, resulting in a significant increase in the prices of cigarettes, which is expected to result in a significant decrease in consumption, particularly among young people.
Effective action to prevent and combat smoking must be continued, especially to support those who wish to quit smoking. This is why it is quite possible to provide for the reimbursement of products that promote smoking withdrawal through health insurance.
The Cancer Orientation Commission was established on 9 September 2002. Its mission is to assess the strengths and weaknesses of the existing control system. It will also need to identify priorities without neglecting any aspects of an organized and national policy to combat cancer, including in the field of prevention, information and testing as well as in the organization of the care system, its functioning and the support of the sick.
The work of this mission will serve as a basis for consultation with all the actors of the system, including the associations of patients, in the field of cancer policy. The Public Health Programming Act will translate the main findings of this mission.
Already, some directions can be indicated. In addition to a sharp increase in budget allocations for cancer control, intrafamilial screening of women at risk for breast cancer will begin in 2003. The necessary means for the generalization of screening will be stopped in 2003 for a complete implementation in 2004. On an experimental basis, twenty departments selected in 2002 will continue the implementation of organized screening of colorectal cancer. At the same time, the modernization of the necessary heavy equipment will be undertaken both for the diagnosis - renovation and extension of medical imaging equipment - and for the therapeutic treatment of cancer with the upgrading of the radiotherapy park. The multidisciplinary care of patients will be developed with the extension of chemotherapy, including at home.


1.2. New governance


The conditions of governance of our health and social security system have revealed today many imperfections that are not new. Paritarism has been weakened since the decision of the Mouvement des entreprises de France (MEDEF) to no longer sit on the boards of the caisses. The Government considers that the organization of social security is prey to great difficulties that cannot be left indifferent.
The Government therefore wishes to lay the foundations for a new governance of the health and health insurance system without delay. This requires a redefinition of the roles of the state and health insurance, which is now too crowded, and a clarification of the funding so that each of the actors is fully responsible for their missions. This reform of the governance of our health and social security system must also take into account the new stage of decentralization decided by the Government. The creation of regional health agencies enters this perspective. These agencies will promote a better articulation of city and hospital medicine, a better association of professionals and patients within the regional framework, a more democratic operation, a greater coherence in the organization of our care system and a greater legibility of the policies being pursued.
The Government has asked all partners to first make a statement of shared location. This is the mission of an ad hoc working group of the Social Security Accounts Commission whose principle was decided in September 2002. Based on this observation, the proposals of the various health and health insurance actors will be collected and will be synthesized at the beginning of 2003. The Government will then present options for governance reform that will be widely discussed. The Government will finally table a bill before the summer of 2003.
Without waiting for this large-scale reform, the Government wishes to mark its determination by three provisions.
It decided to change the way in which the members of the Industrial Accidents and Occupational Diseases Commission were appointed to be directly appointed by social partners. In addition, the commission will be supplemented by a specific supervisory board. The Government also undertakes to table at the spring session a bill for the financing of social security that is rectificative or "social collective" in the event that economic and financial conditions would significantly deviate from the assumptions of this project. In addition, the objective and management agreement between the National Health Insurance Fund (CNAMTS) and the State will be enriched with a chapter on risk management. Negotiations are under way for the signing of an advent at the end of this year.
In the coming months, the Government also intends to open work, including mutuality, and other complementary insurers, on a new sharing of the roles between basic health insurance and supplementary health insurance, and to expand the access of all our fellow citizens to supplementary health coverage.


1.3. A sincere and medically justified ONDAM


Outside 1997, the National Health Insurance Expenditures (ONDAM) target has been consistently exceeded in recent years. In 2002, the surpass of the NDAM is expected to reach more than €3.9 billion.

This drift and ins sincerity, denounced by the Court of Accounts, by parliamentarians and by all actors in the health and health insurance system, have undermined the very credibility of the policy of regulating health insurance expenditures.
As a result of the past and in response to numerous criticisms, the Government has opted for realism, sincerity and transparency in determining the national objective of health insurance expenditures. That is why he now intends to prioritize the evolution of the NDAM on the analysis of the evolution of care activity in our country. This "medicalization" of the national objective of health insurance and accounts expenses, which is widely demanded to give meaning to our health system and to effectively mobilize its actors, is essential.
Such a demanding and complex approach requires many difficult study work. Despite ancient studies, it can reasonably be totally completed in the medium term. It's more reason to start it right away and force the look. It is indeed a matter of developing new tools such as pathology accounts. An important first step was the way in 2002. For example, the new component of the report in Appendix b provides a linkage of changes in health, by pathology, and changes in spending for more than 80% of the consumption of medical care and goods. In particular, it points out that the first two diagnostic categories in terms of expenditures incurred are cardiovascular diseases (11.8 billion euros) and mental disorders (10.4 billion euros).
In addition, the Government has decided to extend the missions of the CNAMTS Supervisory Board, which includes health professionals under the chairmanship of a member of Parliament, following the implementation of the national objective of "medicalized" health insurance expenditures and the coherence of the agreements signed between health insurance funds and health care professionals with respect to the objective.


1.4. Promoting excellence in the care system


The Government will develop, over the next five years, a genuine quality policy in the field of professional practices and in the area of the management of patient care and service structures.
This policy is, above all, part of a public health, health security and the adaptation of our system to technological and scientific developments in the health sector. It also responds to a logic of efficiency and optimization of health spending by contributing to the sustainability of our health insurance system. This ambitious policy involves the development of the evaluation of practices and structures, the initial and ongoing training of professionals, the development of care networks, improved management and strong support for innovation in all areas. It calls for a very important development of the functions performed by the National Agency for Health Accreditation and Evaluation (ANAES).


1.4.1. Public and private hospital excellence:
the "Hôpital 2007" plan


For the past six years, following the establishment of regional hospitalization agencies, public and private hospitalization has shown that it is capable of adapting and restructured (accreditation, introduction of the medicalization program of information systems [PMSI] in hospital management, upgrading effort in health safety standards). However, hospital ill-being has never been so great. This is why the Government's hospital policy will tend to make hospitals closer, more modern and more accountable, while giving them greater internal flexibility.
The proximity, which is a guarantee of efficiency and relevance, is the challenge of deconcentration and, in the long term, the regionalization of our health system. In a first step, it will result in a simplification of the administrative planning procedures and a contractualization of objectives with regional hospital agencies.

The vetty of heritage and hospital facilities requires a significant catch-up in 2003 and for the next five years. The Government's will, beyond the financial contribution, aims to accelerate the implementation of the investment, renovation and recomposition of the hospital offer. To achieve this, three key measures are planned in 2003: first, the regionalization of heavy investment operations; second, the development of the use of delegated masters of work; Finally, a national support mission will be established to technically support regional institutions and agencies in their investment operations. A capital contribution of 300 million euros to public and private institutions is planned for 2003. Combined with borrowings, possible partnerships with private companies or other public actors, this contribution will, thanks to the leverage effect, enable a first investment of over 1 billion euros.
The development of activity-related funding is an essential lever for this modernization. In this way, funding will be fair and transparent between the public and private sectors; cooperation between these different actors will be facilitated. Already, the Government is committed to carrying out a wide-ranging experiment in nature of the pricing for activity based on volunteerism. The goal is to generalize this new pricing method from 2004.
Finally, the accountability of hospital actors requires, on the other hand, greater autonomy and greater managerial flexibility in public institutions. It is envisaged, on the one hand, a substantial strengthening of the authority of the boards of directors, on the other hand, a relaxation of the administrative rules of management within the hospital. Finally, it is necessary to imagine a collective interest of hospital actors in terms of their results in order to establish a "culture" of the result and not exclusively of the means. To support this institution's accountability, the bill now proposes the creation of an audit mission whose objective is to propose diagnostics by allowing a real return of experience to institutions by means of good management practice repositories. The management of hospital structures will need to modernize and ensure an evolution of the internal capacities of the hospital, which is more responsive, as close to the actual expectations of the population.


1.4.2. Development of the quality of city care


Taking note of the failure of the floating key-letter system in our country, the Government has taken the decision to make the choice of a medical mastery that makes the bet of confidence. This confidence is necessary for the signing by the end of 2002, of the new conventions required by the legislation in force. Already, the signing in June 2002 for generalists and July 2002 for paediatricians of agreements containing commitments in terms of good practices shows that the bet of trust is on the right track.
This trust is demanding. She's at the service of the quality of our medicine. The Government takes all its part in this change of attitude. Two measures of the bill testify. Without abandoning the monitoring of the application of the regulations, the medical control of the general health insurance funds is redirected to the counselling and promotion of the proper use of care. This service will offer health professionals a genuine dialogue around a joint analysis of their activity. On the other hand, the City Care Quality Assistance Fund's missions are expanded to fund actions to assess practices.
In return, professionals, in a spirit of shared responsibility, must engage in ongoing medical training, evaluation and coordination of care, particularly in the conventional framework. The strength of their commitment depends largely on our collective ability to reconcile a high level of social protection and the best quality of care.

In order to combat desertification, isolation and security problems, the Government promotes and encourages initiatives to ensure the permanence of care, with all local actors, including by providing physicians with the opportunity to apply to several sites.


1.4.3. A modern and balanced drug policy


Drug spending in France is one of the highest in the world in per capita volume. However, the annual growth in drug expenditures reimbursed by health insurance plans in the city remains strong (+10.1% in 2000, + 9.2% in 1999).
The arrival of more costly innovative molecules, the extension of the duration of treatments related to the growth of chronic pathologies and the general aging of the population are the main determining factors of this evolution that weighs on the accounts of health insurance.
Our drug policy must evolve in order to give more room to research and innovation for the benefit of patients and to guarantee good use of public money. It must also appeal to the responsibility of this major actor that is the pharmaceutical industry, within the framework of a close and confident partnership with the State. There is also a need to better guarantee strict respect for ethical requirements to prevent harmful drift to patients and ultimately to the pharmaceutical industry itself.
Promoting drug innovation is a key factor in the excellence of the French care system. This requires faster access than today from patients to the new most innovative drugs in the field of city care. An evolution of existing administrative procedures and the establishment of an accelerated access to reimbursement in the city will achieve this goal. Promoting innovation also requires a significant increase in the hospital budget for these drugs. Finally, it is to help and encourage biotechnology companies by facilitating the marketing of their products. This choice is necessary to prepare the future. Already more than 50% of new drugs are the fruit of biotechnology.
It is legitimate that health insurance is even more concerned about the money of contributors and the medically justified nature of what it pays. As a matter of priority, it is therefore necessary to continue the development of generic drugs whose market share is still too limited in France (6 per cent versus 20 per cent in some neighbouring countries). The efforts made for several years, in partnership with doctors, pharmacists and laboratories, will be intensified, as well as the effects of the June 5, 2002 agreement between the health insurance funds and the representative organizations of the liberal doctors must be amplified. The Government is determined, as the Court of Auditors invites, to streamline the procedures for the purchase of medicines in the hospital.
The Government also decided to establish a reimbursement package for drugs belonging to a generic group. It is not legitimate, in fact, that health insurance is obliged to reimburse at different rates two identical efficacy medications for the patient (same molecule). In addition, the Government wishes to draw all the consequences of the recent re-evaluation of the medical service rendered by drugs. The implementation of this decision, surrounded by all procedural and impartial guarantees, will be phased over a three-year period to allow patients and doctors to adapt their behaviours and industry to adapt their strategies.
Giving more legibility and stability to the economic and regulatory environment of industrialists is also an important focus of the Government's new policy. The sectoral agreement, which must be renewed in the coming months, is a major instrument. A reform of the specific taxation that weighs on pharmaceutical laboratories in the sense of simplification is also one of the essential aspects. A first step will be completed in 2003. A next step will be prepared as part of a consultation with representatives of the pharmaceutical industry.


1.4.4. Patient accountability


Patients and insured persons are central to the health system. The French system guarantees them great freedom of choice in the use of care due to high rates of reimbursement and free access to all professionals. This freedom must have more for consideration a genuine accountability on their part.
Patient and insurance accountability tools will be developed in consultation with partners. The shared computerized medical record, which was made possible by the Law on the Rights of the Sick of 4 March 2002, is one of those accountability tools that the Government wishes to develop rapidly on the basis of volunteerism. The funding bill provides for another significant measure of accountability: the reimbursement package for generic groups. Insured persons to whom a generic group medication will be prescribed will be reimbursed under the same conditions, whether they accept a generic or ask for the princeps medication, the choice returning them. Agreing to the objectives and management convention with the NCAMTS will seek to develop other tools in this objective.


1.4.5. Persons with disabilities


The improvement of the situation of persons with disabilities is one of the three major construction sites of the quinquennium that the President of the Republic launched on 14 July 2002. The objective of a disability policy is to enable persons with disabilities to choose their way of life and to participate in society as far as possible. 90% of people with disabilities live at home today. Some of them do so by choice, but others are forced to do so because of lack of places in the establishment (specialised reception homes or accommodation homes). In fact, this lack of space requires more than 2,000 families to send their children to Belgium. As a result, the Government wishes to develop, in 2003, and in the course of the legislature, the necessary places to meet these needs and to provide the necessary assistance to those living in the home (nursing care, nursing assistants, household help...).
Another part of this major project is the revision of the Guidance Act of 30 June 1975. The new law, which will be tabled in 2003, will, inter alia, express national solidarity with all persons with disabilities by affirming and reorganizing their right to care for the technical and human assistance necessary to compensate for their disability.
These major projects do not prevent concrete and immediate action. Creations of life support and school integration positions are set out in the 2003 Finance Bill. 3,000 places in the center of work assistance are created in 2003, a double of the effort to create places, to promote the professional integration of persons with disabilities who cannot access the ordinary workplace. The number of places in the establishment (specialized reception houses, medical shelters) is also doubled to decrease the current waiting lists and give a place to young adults and poly-disabled people who are currently staying in youth facilities (about 4,000 people). These creations must address the new needs that are opening up, in particular because of the ageing of persons with disabilities.


1.4.6. Older persons


France must give all its place at age in our society. We need to be able to age it with dignity.
To be respected in his dignity, integrity, his needs for dialogue, exchange, social relations, to be heard on requests for health, hygiene of life, to enjoy a satisfactory level of income and living conditions, such are the wishes of the elderly today. It is the hope of all those who advance in age and, tomorrow, of each.
Compared to previous generations, the population lives longer. Obligation is made to the public authorities to give meaning to these years added to life expectancy. But this elongation of life that opens so many new possibilities is often accompanied by a loss of autonomy, normal risk in the lives that lie down.

Act No. 2001-647 of 20 July 2001 on the management of loss of autonomy gave older persons a new right, the right to autonomy.
Public health policy should also improve the care of older persons through the development of age-related disease knowledge and support for geriatric care.
In the area of care specific to older persons, the Government ' s priority is the implementation of the reform of the pricing of institutions hosting dependent older persons.
The objectives of pricing reform are maintained:
- offer an enhanced quality of care in each establishment through the commitment of a quality approach;
- reduce tariff inequalities and make the allocation of resources more equitable;
- clarify the costs (accommodation, care and dependency) and the scope of competence of each funder.
The slow pace of signing of the conventions reflects the difficulties of implementing the reform due to an evolving and complex regulation, which required a time of ownership by the actors as well as a strong mobilization of stakeholders on the implementation of the thirty-five hours, the personalized allocation of autonomy (PAA) and the new accounting rules. Therefore, forging a signature of all conventions by 2003 is unrealistic.
The goal is to sign all the conventions by 2005 and to engage in an incentive and proactive approach to achieve this goal.
In order to resolve the most difficult cases and to take into account the inevitable delays encountered by some signatories, it is proposed to postpone the due date to 2006. Thus, all procedures will be completed correctly.
For 2003, there are plans to obtain the signature of 1,800 tripartite conventions.
With regard to ongoing multi-year programmes in the elderly sector, they will be continued.
Among the public health priorities, neurodegenerative diseases, including Alzheimer's disease, and their dramatic consequences will be taken into account especially by developing family support and daytime reception.


2. The industrial accident branch
2.1. Improve branch management


The Government wishes to register in the continuity of the Act of 25 July 1994, which recognized the autonomy of the occupational accident and disease industry. To this end, the branch will have a convention of objectives and management and a supervisory board. Such tools will significantly improve branch management.
In addition, despite a degraded accounting situation, the Government has complied with the recommendation of social partners, gathered within the Industrial Accidents and Occupational Diseases Commission, to stabilize the contribution rate.
Finally, the clarification of the social security accounts requires that the expenses of each branch be properly charged, which requires a training effort for the various actors (health professionals, hospitals) and to carefully study the causes of the under-reporting of occupational accidents and diseases.

In the meantime, after extensive work on this subject, the minimum assessment of expenses wrongly charged to the sick branch was estimated, by the commission established by Article L. 176-2 of the Social Security Code, to 330 million euros. This amount was used to determine the transfer between the two branches.


2.2. Study the consequences of a possible passage
for integral repair


Following Mr. Roland Masse's report, Mr. Michel Yahiel was responsible for conducting a reflection on the methodology of putting in place an integral repair of professional risks. This report was issued in April 2002.
In particular, given the development of "common law" repair systems and the evolution of jurisprudence, the legislation of industrial accidents and occupational diseases, which is based on the April 1898 "compromising" merits a thorough review. The evolution to the so-called "full" repair is thus one of the possibilities of evolution of the branch. However, as pointed out in Mr.Yahiel's report, "the poverty of the information available to inform possible decisions," the absence of serious elements of analysis on the economic implications of the possible choices "from a general point of view, but also from the perspective of the gains and losses to be expected for victims" show "the extreme uncertainty surrounding the conditions of realization and the consequences of full reparation, starting with its cost".
The Government has therefore entrusted Mr.Yahiel with the task of conducting a steering committee involving key actors to deepen the expertise on full reparation in its legal, financial and organizational aspects. Once this evaluation is known, the Government will then be based on broad consultation, particularly with social partners.


2.3. Taking into account the harm suffered
by the victims of asbestos


As soon as it was appointed, the Government wished that the mechanisms for redressing the harm suffered by persons with asbestos-related illness be put in place quickly. The Asbestos Victims Compensation Fund, after defining the deposit amounts in June 2002, is in the process of finalizing the scale. It will have a payout of the industrial accidents and occupational diseases industry of 190 million euros in 2003.


3. Family policy


The Government decided to deflect from 2003 the policy for the benefit of families as part of the Social Security Financing Bill, but also as part of the financial bill.
In that spirit, it decided to put in place a targeted measure on the large families with large children as a priority. Today, family allowances are only collected from the second child and are largely discontinued when children reach the age of twenty. This system can cause great imbalances in the budgets of the most modest families, the children who remain dependent on their parents for a growing period, far beyond their twenty years.
The Government's objective is to mitigate the brutal nature of this loss of family allowances. The measure is targeted at families of three or more children, for which the most significant financial loss is. For example, an amount of EUR 70 per month will be paid as of July 1, 2003, for one year to these families whose elder is twenty years old. The benefit for the 145,000 families concerned will be EUR 840.
In the 2003 Finance Bill, the Government has also provided for the doublement of the slaughter for donations between grandparents and grandchildren that will revitalize the financial solidarity effort among generations. Similarly, the increase of 50% of the thresholds for family employment will encourage all families who employ children's guards or persons to relieve the elderly from family or household tasks.

In addition, for the sake of clarification, the increase in the coverage by the National Fund for Family Allowances for Child Retirement Increases will continue. The rate of care will reach 60% in 2003.
The deadlines for the Government have not allowed to go beyond this inflection. The 2003 Family Conference will mark the beginning of a more fundamental reform of family policy. The preparatory work for this conference, launched in early October 2002, will be marked by the seal of ambition and realism. Ambition because it is time to build up the major inflections expected by all partners, including the creation of a unique free choice service. Realism because family policy is based on complex balances and our financial environment is constrained. The working groups that will prepare the spring 2003 conference will focus on, as a matter of priority, their reflection on issues related to the simplification of services, services for families and the conciliation of family life and work life. The Government is committed to examining in its entirety the situation of widows, in particular the increase of 10% of mothers, the increase in the resource ceiling and the amount of widow insurance.


4. Old-age insurance policy
4.1. Refusing Attemptism


With an exceptional demographic context, the old age branch is surplus. As the various reports that have taken place in France for at least ten years have shown, this favourable situation will be extremely brief. The "diagnosis" of funding needs, by 2020 and by 2040, is perfectly established.
The main danger to our distribution pension plans would be inaction. Their backup would then weigh all its weight on a relatively small number of generations, which could then refuse an additional effort.
Pension revalorization in 2003 will be 1.5%, in accordance with expected inflation. This revalorization will ensure the maintenance of the purchasing power of retirees. Any additional effort would presume the current and future balance of the branch.


4.2. Building fairness reform,
freedom and shared effort


In accordance with the Prime Minister's general policy statement of July 3, 2002, this reform will be based on the following principles:
- it must lead to greater equity between the French, while taking into account the specificities and different statutes and of course the diversity of situations, including demographics;
- the freedom of choice will be ensured: retirement at sixty years, which is a social achievement, will not be challenged, but those who wish to extend their activities beyond must be able to do so and thus increase their rights;
- the necessary efforts will be equitably distributed.
The fundamental principles of reform will be clarified, in conjunction with social partners, in early 2003. Each regime, private or public, will then be subject to specific treatment, according to an appropriate schedule and terms to be negotiated on a case-by-case basis.

This is the time for decision-making. Our pension system is our common good. The conditions for its preservation, which will be agreed in the context of the renewal of social dialogue, will be met before the end of the first half of 2003.


5. Financing and balance of social security


In the area of financing and balance of social security, the Government is committed to committed to the credibility of its objectives and to progress in the area of clarification.


5.1. Commitment to the credibility of objectives


The credibility of the objectives of the funding laws of previous years has been challenged by significant overruns in spending targets, particularly for the disease industry. Such overruns have led the previous government to propose the vote of targets rectified in the Social Security Financing Bill. However, an addition of the objectives of the current year to the objectives of the following year does not allow for a real debate on the justification of overtakings.
The Government therefore wishes to change its approach to making their credibility the objectives of the financing laws. In this way, it undertakes to submit to Parliament at the beginning of May a bill of rectificative funding, in the event that the forecast of revenues and expenditures made under the Spring Accounts Committee would show a significant offset to the targets set out in the Funding Act for 2003.
The presentation of the Corrigendum Funding Bill will be an opportunity to discuss the reasons for these differences between aggregates and objectives, whether positive or negative. It will propose a number of measures to draw its consequences in terms of the supervision of the social security system, in terms of effort provided by the various actors or in terms of their benefits.


5.2. Enhancing social security financing,
in particular financial relations with the State


The Government ' s second priority is to clarify the financing of social security.
As the audit of public finances shows, social security accounts are currently characterized by real opacity. Many funding channels have been established in recent years. In addition to their complexity, these circuits are described by the various partners, as they lead to the social security financing of expenses that do not fall into the object.
The importance of the amounts at stake and the complexity of the links between different organizations make this inevitable clarification a medium-term objective.
The situation and constraints on public finances do not allow for a complete clarification in a single year. In 2003, it seemed essential to the Government, however, to undertake a very significant first step. This includes three key components:
- the State's commitment to fully compensate for new expenses;
- a reassignment to social security of a portion of the income that had been used for the financing of the Fund for the Reform of Social Security Pensions (FOREC). The modification of the tobacco rights-sharing keys between FOREC and CNAMTS will bring to the latter 700 million euros and will return to the sharing key prevailing prior to the creation of FOREC;
- the reimbursement of half of the debt spent on alleviating expenses.
This is the safeguard of our social security, which it is today. It passes through a modernization of its organization and its structures that allows to adapt to its new environment. The Government ' s path is clear. Its resolution is also. It is in the long term, in the dialogue and respect for social dialogue that reforms will be carried out.


Done in Paris, 20 December 2002.


Jacques Chirac


By the President of the Republic:


The Prime Minister,

Jean-Pierre Raffarin

Minister of Social Affairs,

and solidarity,

François Fillon

The Seal Guard, Minister of Justice,

Dominica Perben

Minister of Foreign Affairs,

Dominique de Villepin

Minister of Economy,

finance and industry,

Francis Mer

Minister of Health, Family

and persons with disabilities,

Jean-François Mattei



The Minister of Public Service,

of State Reform

and landscaping,

Jean-Paul Delevoye

Minister for Budget

and budgetary reform,

Alain Lambert

Minister Delegate

European affairs,

Christmas Lenoir

Secretary of State

relations with Parliament,

Government spokesperson,

Jean-François Copé



(1) Act No. 2002-1487.
- Preparatory work:
National Assembly:
Bill No. 250;
Report of Mr. Yves Bur, Jean Bardet, Ms. Marie-Françoise Clergeau and Mr. Denis Jacquat, on behalf of the Cultural Affairs Committee, No. 330;
Opinion of Mr. François Goulard, on behalf of the Finance Committee, No. 327;
Discussion on 28, 29 and 30 October 2002 and adoption on 30 October 2002.
Senate:
Bill, adopted by the National Assembly on first reading, No. 47 (2002-2003);
Report of Mr. Alain Vasselle, on behalf of the Social Affairs Committee, No. 58 (2002-2003);
Opinion of Mr. Adrien Gouteyron, on behalf of the Finance Committee, No. 53 (2002-2003);
Discussion on 18, 19 and 20 November 2002 and adoption on 20 November 2002.
National Assembly:
Bill, amended by the Senate, No. 389;
Report of Mr. Yves Bur, on behalf of the Joint Parity Commission, No. 394;
Discussion and adoption on 27 November 2002.
Senate:
Report of Mr. Alain Vasselle, on behalf of the Joint Parity Commission, No. 78 (2002-2003);
Discussion and adoption on November 28, 2002.
- Constitutional Council:
Decision No. 2002-463 DC of 12 December 2002, published in the Official Gazette of this day.


Download the document in RTF (weight < 1MB) Facsimile (format: pdf, weight < 3.5 MB) Download the document in RDF (format: rdf, weight < 1 MB)