La longue marche du remboursement des psychothérapies par l’assurance maladie en France

Objectives

To outline the procedure for obtaining reimbursement by the French National Health system for psychotherapy provided by private practitioners.

Method

By conducting a review of scientific literature, reports, plans, and governmental decisions.

Results

Some twenty years have passed since a recommendation was included in the “plan of action for the development of psychiatry and the promotion of mental health”, which was drafted in 2003. The contribution of epidemiology applied to psychotherapeutic practices in France, and comparisons with neighboring countries, highlighted the quantitative importance of the role of psychiatrists (they provide more than half of all psychotherapeutic interventions) in the implementation of the plan of action, including in the least endowed areas of the country. The 2010 decree on the use of the title of psychotherapist was an essential preliminary step, since, previously, no requisite training was required for that title, which involved substantial risk. Henceforth, fundamental and clinical knowledge have been imposed with mandatory limits of duration. Subsequently, the publication of high expenditures on mental health by the French National Health Program coupled with the establishment of the reimbursement for psychotherapy in the United Kingdom, resulted in a promising French medico-economic study as well asan experiment in four departments involving patients between the ages of 18 and 60 who were suffering from mild and moderate anxious and depressive disorders. The diagnoses were based on PHQ9 and GAD7 being applied by the general practitioner, excluding the most severe cases, which allowed them to provide their patients with an evaluation session by an office-based psychologist followed by 10 sessions of “supportive therapy”. In the case of no improvement, an evaluation by a psychiatrist was required before providing 10 additional “structured therapy” sessions. After a two-year evaluation period, the process was determined to be beneficial for patients, general practitioners, and the psychologists who were involved. This led to the establishment, in 2022, of an on-line platform labeled “Mon Parcours Psy” (My Psychiatric Path) which facilitates the payment for 8 sessions per year of psychotherapy treatment for minor disorders for patients as young as 3 years of age., Parental authorization is required for minors.

Discussion

The prescription of psychotherapy by general practitioners for mild or moderate disorders and the price of services provided by psychologists have been the object of criticism by the members of this profession: both the quantity of prescriptions and the tariffs for such services were deemed to be too low.

Conclusions

Making psychotherapy provided by psychologists available to the public at large, thanks to the introduction of a system to cover the costs involved by the the French National Health Insurance, is an important step forward for several reasons: it improves the relationship between psychologists and general practitioners; it decreases the use of psychotropic drugs, often the only solution for such patients; it will potentially relieve the pressure on the public psychiatric system, allowing it to refocus on the most severe patients. However, its implementation and results remain to be evaluated.