As a result of the August-2004 reform Law, the responsibilities of CNAMTS have increased, been reinforced and supported by tools with which it can optimise how the healthcare system is run. The CNAMTS implements the coordinated treatment pathway by putting the referring doctor at the centre of the system. It ensures that expenditure is balanced with the public resources allocated to it, and is thus the key player in the healthcare system for which it ensures medical control.
Different risk management actions
To successfully fulfil its missions, the activities of the CNAMTS particularly consist in:
- Defining the guidelines, principles and objectives guiding its action and the one of the Health Insurance System in general, and ensuring their implementation.
- Ensuring the implementation of "convention-type" agreements concluded between the UNCAM and representative trade unions of healthcare professions, and the establishment of the coordinated treatment pathway.
- Organising and running the Health Insurance Medical Service (service médical de l'Assurance Maladie).
- Determining and coordinating the activity of organisations of the occupational health and safety branches (CPAM, CRAM, ...), negotiating and allocating the budgets to local funds within the framework of CPGs, and providing advice and support to its sector's network.
- Developing medical control and supporting the changes in participants' behaviour.
- Defining and promoting the prevention of occupational illnesses and accidents by taking useful national measures.
- Managing the risk policy of the whole healthcare system, through the Regional Hospitalisation Agencies (agences régionales d'hospitalisation / ARH) and the medico-social policy through the Regional Health Insurance Funds (caisses régionales d'assurance maladie / CRAM).
Tools for the CNAMTS to run its mission
The CNAMTS exercises its responsibilities in a public-service attitude and in accordance with the Management Objectives Convention and the National Objective of Healthcare Expenditure :
- The Management Objectives Convention (convention d'objectifs et de gestion / COG), concluded for 4 years between the State and the CNAMTS, determines the pluriannual management objectives, the operational means to achieve them and the measures it is necessary to take.
The COG for 2006-2009 focuses on the corporate plan guidelines, based on three key objectives: fully carrying out our management mission of occupational health and safety, expanding our range of services and a way of providing it, increasing our efficiency. - The National Objective of Healthcare Expenditure (objectif national des dépenses de l'assurance maladie / ONDAM) is the planned budget for healthcare expenditure in towns and hospitals, annually voted by the Parliament. It is a healthcare expenditure regulation mechanism based on the definition of objectives quantified by profession and obtained from a negotiated medico-administrative evaluation of expected expenditure.
