- CNAMTS’ missions

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CNAMTS’ missions

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Article mis à jour le 26 juillet 2012
CNAMTS, a jointly liable health insurer, defines risk management policies and steers the network of the institutions in charge of their implementation.

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, CNAMTS'activities 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 health insurance fund national union (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: local health insurance funds (CPAMs), and retirement and occupational safety funds (CARSATs which are former CRAMs*), negotiating and allocating the budgets to local funds within the framework of pluriannual management agreements (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.

* Since the 1st of July 2010, CRAMs - excepted Ile-de-France one - have changed identity. They are now CARSATs. This change has occurred due to the creation of Health Regional Agencies « ARS ». ARS are now in charge of the missions that used to be devoted to CRAMs as far as health, social and medical policies are concerned.

Tools for CNAMTS to run its mission

CNAMTS exercises its responsibilities in a public-service attitude and in accordance with the Management and Target Agreement (COG) and the National Objective of Healthcare Expenditure (ONDAM) :

  • The Management and Target Agreement (convention d'objectifs et de gestion / COG), concluded for 4 years between the State and CNAMTS, determines the pluriannual management objectives, the operational means to achieve them and the measures it is necessary to take.
    In the COG for 2010-2013 framwork (an electronic version of which can be got below), during the coming four years, the State and the Health insurance will focuse on:
    - Going thoroughly into risk management that is considered as the heart of Health insurance action.
    - Strengthening and diversifying a good quality service offer towards insured people.
    - Going on improving Health insurance 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.

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