›› Attending Physician Agreement

Preamble

Through this agreement, we are jointly committed to improving access to high-quality care for all, and to better rewarding your practice in recognition of your commitment to prevention, monitoring chronic pathologies, optimising prescriptions and modernising medical practices.

The standard agreements set out in Executive Decree No. 09-116 of April, 07, 2009 define the relationship between the social security body and the general practitioner in private practice, appointed as the « attending physician », to provide medical services for insured individuals and their dependants.

Pending their generalisation to all insured individuals, these agreements currently apply to

• Recipients of direct or reversionary retirement pensions and their dependants.
• Recipients of direct or reversionary retirement allowances and their dependants.

Objectives of the agreement

The aim of the agreement with the « attending physician » is to improve the organisation of healthcare referrals and the medical monitoring of insured individuals and their dependants, as well as to develop a partnership to promote the quality of care, prevention and to rationalise healthcare expenditure.

It also helps to promote high-quality care for chronic conditions such as hypertension, diabetes, and chronic kidney failure.

The attending physician coordinates the care provided to the patient in conjunction with other healthcare professionals. As part of this process, patients first, consult their attending physician, who will advise them according to their situation and refer them to another practitioner: the doctor specialising in their field. The choice of attending physician for patients covered by social insurance also applies to their dependants.

This choice is expressed jointly by the insured individual and his or her doctor, by filling in a « choice of attending doctor » form.

The attending physician commits to

• Provide initial health treatment and care within his remit;
• Ensure the appropriate coordination of care, in particular by summarising the information provided by the various parties involved and incorporating it into the patient’s medical file;
• Referring the patient, where necessary, to a specialised doctor;
• Contribute to monitoring patients suffering from chronic illnesses, in liaison with other healthcare professionals, in accordance with the care protocol drawn up in accordance with the provisions of the agreement ;
• To observe, in all his activities and prescriptions, the most rigorous economy that is compatible with the quality, safety, and effectiveness of care, by complying with the benchmarks of good medical practice or, in the absence of such benchmarks, with recent scientific data.
• To keep and update a medical file for each patient he treats in his capacity as attending physician.

He also commits to taking preventive action to :

• Identify and eliminate individual risk factors for serious illness (patients who consume tobacco and/or alcohol) ;
• Early detection of serious and costly diseases (breast cancer, cervical cancer)
• Vaccinate population groups with a high risk of morbidity and mortality in the event of influenza (people aged 65 and over; patients with chronic lung, heart, kidney, and metabolic diseases, etc.).

Beyond these guidelines, certain specialised healthcare services are defined as « direct access », meaning that patients do not need to go through their attending physician to access them.

Exceptions have been made for emergencies and when the patient is far from home.

In emergencies and when the patient is far from his usual place of residence, he may consult a doctor other than his attending physician.

Remuneration

Extra amounts are paid to doctors who prescribe generic drugs or drugs that are manufactured in Algeria.

A fee per insured individual is also paid to the attending doctor by the social security body in consideration of his or her preventive work.

For specialist doctors, the amounts for medical consultations and services relating to the monitoring and coordination of treatment are remunerated and increased in situations where generic drugs or drugs that are manufactured in Algeria are prescribed.

In addition, there is an honorary service for monitoring and healthcare protocols for insured individuals suffering from chronic illnesses.

Some essential procedures for various specialities have been integrated into the third-party payment system as part of the « attending physician » scheme.

These include eye tests, audiograms, respiratory function tests, gastroduodenal fibroscopy, rectoscopy and colonoscopy, electrocardiograms and echocardiography, cervico-vaginal smears, obstetric ultrasounds and electroencephalograms.