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Dans la majorité des cas, les centres de santé effectuent un travail de qualité et participent grandement à améliorer l’accès aux soins de nos concitoyens. En 2009, l’obligation d’obtenir un agrément délivré par l’autor ité administrative avant toute ouverture d’un centre de santé a été supprimée. L’objectif poursuivi par cette suppression était de renforcer l’accessibilité de l’offre de soins. Toutefois, il a été constaté au cours des dernières années que cette simplification a mené en réalité à de nombreuses pratiques contraires à la réglementation en vigueur. L’affaire DENTEXIA en 2016 a marqué tous les esprits : surtraitement, surfacturation, mutilations, manquement à la déontologie, etc. À la suite de ce scandale, le Gouvernement, par l’ordonnance n° 2018-17 du 12 janvier 2018, a mis en œuvre des avancées concrètes pour contrôler davantage les conditions d’ouverture et de fonctionne ment de ces centres. Mais cela s’est révélé insuffisant : en octobre 2021, l’Agence régionale de santé (ARS) de Bourgogne-Franche-Comté prononce la fermeture d e deux centres PROXIDENTAIRE situés dans les communes de Chevigny-Saint-Sauveur et de Belfort, à la suite de la constatation de graves dérives dans les soins qui y étaient prodigués. Face à l’ampleur de la situation, un Collectif d’usagers de PROXIDENTAIRE s’est co","articles":[{"num":"1er","extrait":"Après le deuxième alinéa de l’article L. 6323-1-11 du code de l a santé publique, sont insérés trois alinéas ainsi rédigés : « Les centres de santé ou leurs antennes ayant une activité dentaire sont soumis, pour leurs seules activités dentaires, à un agrément du directeur général de l’agence régionale de santé qui vaut autorisation de dispenser des soins aux assurés sociaux dans le centre ou l’antenne concernée. « Les centres de santé ou leurs antennes ayant une activité ophtalmologique sont soumis, pour leurs seules activités ophtal mologiques, à l’agrément du directeur général de l’agence régionale de santé qui vaut autorisation de dispenser des soins aux assurés sociaux dans le c e n t re o u l’antenne concernée. « Les centres de santé ou leurs antennes ayant une activité gynécologique sont soumis, pour leurs seules activités gynécologiques, à l’agrément du directeur général de l’agence régionale de santé qui vaut autorisation de dispenser des soins aux assurés sociaux dans le c e n t re o u l’antenne concernée. »"},{"num":"2","extrait":"L’article L. 6323-1-5 du code de la santé publique est complété pa r des II à IV ainsi rédigés : « II. – Un chirurgien-dentiste responsable de la qualité et de la sécurité des soins dentaires et des actes professionnels est nommé par le gestionnaire dès lors que le centre ou l’une de ses antennes assure une activité dentaire. Il bénéficie des règles d’indépendance professionnelle reconnues aux chirurgiens-dentistes dans leur code de déontologie. « Lorsque des décisions prises par le gestionnaire du centre de s a n té apparaissent au chirurgien-dentiste responsable comme étant de nature à porter atteinte à la santé des patients et la santé publique, l e chirurgien-dentiste responsable en informe sans délai le directeur général de l’agence régionale de santé qui prend alors les mesures appropriées. « III. – Un médecin ophtalmologiste responsable de la qualité e t de la sécurité des soins ophtalmologiques et des actes professionnels est nommé par le gestionnaire dès lors que le centre ou l’une de ses antennes assure une activité ophtalmologique. Il bénéficie des règles d’indépendanc e professionnelle reconnues aux médecins dans leur code de déontologie. « Lorsque des décisions prises par le gestionnaire du centre de s a n té apparaissent au médecin ophtalmologiste responsable comme étant de nature à porter atteinte à la santé des patients et la santé publique, le médecin ophtalmologiste responsable en informe sans délai le directeur général de l’agence régionale de santé qui prend alors les mesures appropriées. » « IV. – Un médecin gynécologue responsable de la qualité et de la sécurité des soins gynécologiques et des actes professionnels est nommé par le gestionnaire dès lors que le centre ou l’une de ses antennes assure une activité gynécologique. Il bénéficie des règles d’indépendance professionnelle reconnues aux médecins dans leur code de déontologie. « Lorsque des décisions prises par le gestionnaire du centre de s a n té apparaissent au médecin gynécologue responsable comme étant de nature à porter atteinte à la santé des patients et la santé publique, l e médecin gynécologue responsable en informe sans délai le directeur général de l’agence régionale de santé qui prend alors les mesures appropriées. »"},{"num":"3","extrait":"Le chapitre III du titre II du livre III de la sixième partie d u code de la santé publique est ainsi modifié : 1° Le premier alinéa de l’article L. 6323-1-10 est complété par une phrase ainsi rédigée : « Le projet de santé comporte notamment la copie des diplômes e t, le cas échéant, des contrats de travail des chirurgiens-dentistes exerçant au sein du centre de santé ayant une activité dentaire, des contrats de travail des médecins ophtalmologistes exerçant au sein du centre ayant une activité ophtalmologique, des contrats de travail des médecins gynécologues exerçant au sein du centre ayant une activité gynécologique. » ; 2° L’article L. 6323-1-11 est ainsi modifié : « a) Après le premier alinéa, sont insérés trois alinéas ainsi rédigés : « Le directeur général de l’agence régionale de santé transmet, pour les centres de santé ou leurs antennes ayant une activité dentaire, la copie des diplômes et des contrats de travail des chirurgiens-dentistes exerçant au sein du centre au conseil départemental de l’ordre des chirurgiens-d entistes qui rend un avis motivé dans un délai de deux mois. « Le directeur général de l’agence régionale de santé transmet, pour les centres de santé ou leurs antennes ayant une activité ophtalmologique, la copie des diplômes et des contrats de travail des médecins exerçant au sein du centre au conseil départemental de l’ordre des médecins qui rend un avis motivé dans un délai de deux mois. » ; « Le directeur général de l’agence régionale de santé transmet, pour les centres de santé ou leurs antennes ayant une activité gynécologique, la copie des diplômes et des contrats de travail des médecins exerçant a u sein du centre au conseil départemental de l’ordre des médecins qui rend un avis motivé dans un délai de deux mois. » « b) À la première phrase du deuxième alinéa, les mots : « cet engagement » sont remplacés par les mots : « l’engagement de conformité mentionné au premier alinéa. »."},{"num":"4","extrait":"L’article L. 6323-1-12 du code de la santé publique est complété par un alinéa ainsi rédigé : « À la suite de la suspension, totale ou partielle, de l’activi té ou de la fermeture du centre ou, lorsqu’elles existent, de ses antennes, le directeur général de l’agence régionale de santé peut refuser de délivrer le récépissé de l’engagement de conformité relatif à l’ouverture d’un nouveau centre de santé ou d’une antenne lorsque ce récépissé est demandé par le même organisme gestionnaire ou par le même représentant légal jusqu’à la levée de cette suspension ou pour une durée maximale de cinq ans dans le cas d’une fermeture définitive. »"}],"pdfUrl":"https://www.assemblee-nationale.fr/dyn/16/textes/l16b0361_proposition-loi.pdf","pdfPages":null},"dispositionsVersion":6},"stade":{"cle":"intermediaire","etiquette":"Lecture intermédiaire","phrase":"Ce dossier est devenu la loi, promulguée le 19 mai 2023, mais ce texte n'en est qu'une étape : la loi peut en différer.","garde":"Ce résumé décrit cette étape du texte. 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l’Assemblée adopte en deuxième lecture la proposition de loi visant à améliorer l’encadrement des centres de santé, par 82 voix, aucune contre et 4 abstentions.\n\nLe texte réécrit l’article L. 6323-1-11 du code de la santé publique, qui régit l’agrément et le contrôle des centres de santé. Il s’agit d’encadrer des structures dont certaines pratiques, notamment tarifaires, avaient été mises en cause.\n\nPERSONNE NE VOTE CONTRE. La France insoumise est le seul groupe à s’abstenir, avec les 4 abstentions du scrutin. Tous les autres votent pour, du Rassemblement national aux Écologistes.","dynamique":"Adopté le 28 mars 2023 : 82 voix pour, aucune contre, 4 abstentions. Neuf groupes ont voté pour et un s’est abstenu.","arguments":{"pour":[{"qui":"Fadila Khattabi, rapporteure de la commission des affaires sociales (Renaissance)","texte":"Fait remonter le problème à la loi de 2009 dite loi Bachelot, « qui a supprimé l’agrément préalable à l’ouverture de tout centre de santé », d’où « une augmentation exponentielle de leur nombre ». Elle cite « les scandales sanitaires de Dentexia en 2016 et de Proxidentaire en 2021, laissant de nombreux patients ayant subi de très graves mutilations dans la plus grande détresse sociale », tout en rappelant qu’« un grand nombre de ces centres répondent aux attentes de nos concitoyens et effectuent un travail de qualité ».","source":"Compte rendu de la 3e séance du 28 mars 2023 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/16/comptes-rendus/seance/CRSANR5L16S2023O1N195#3069629"},{"qui":"Groupes Renaissance, Rassemblement national, Les Républicains, Mouvement démocrate, Socialistes et apparentés, Horizons, Écologiste, Gauche démocrate et républicaine et LIOT","texte":"Ont voté pour, sans une seule voix contre dans aucun de ces neuf groupes.","source":"Analyse du scrutin n° 1315, Assemblée nationale, 28 mars 2023","url":"https://www.assemblee-nationale.fr/dyn/16/scrutins/1315"}],"contre":[],"reserves":[{"qui":"Groupe La France insoumise","texte":"S’abstient sans exception : ses 4 abstentions sont la totalité de celles du scrutin.","source":"Analyse du scrutin n° 1315, Assemblée nationale, 28 mars 2023","url":"https://www.assemblee-nationale.fr/dyn/16/scrutins/1315"}]},"sources":[{"label":"Analyse du scrutin n° 1315, Assemblée nationale, 28 mars 2023","url":"https://www.assemblee-nationale.fr/dyn/16/scrutins/1315"}],"v":2,"source":"cure-verifie"},"explain":{"scrutinId":"VTANR5L16V1315","version":2,"titre":"l'ensemble de la proposition de loi visant à améliorer l'encadrement des centres de santé (deuxième lecture).","synthese":"**L'Assemblée nationale** a **adopté** une proposition de loi visant à **améliorer l'encadrement des centres de santé**, lors d'un **scrutin public ordinaire** le 28 mars 2023. Le texte, examiné en **deuxième lecture**, a reçu l'appui de plusieurs groupes parlementaires, notamment **RE, RN, LR, DEM, HOR et LIOT**. Aucun groupe n'a voté contre, mais quatre députés se sont abstenus. 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