Price of consultations: 2000 doctors threaten to quit, what are the consequences for the patient?
More and more general practitioners are threatening to give up health insurance. Some want to revise their patients’ consultation fees upwards. What is the purpose of the agreement, what are the risks for a patient if his doctor does not agree? The Midi Expedition explains to you.
The relationship between licensed doctors and social security is still fragile. Dr. Jérôme Marty, president of the French Union for Free Medicine (UFML), published on Twitter, on Tuesday 16 May, a census with more than 1,950 doctors ready to present their letter of deconvention.
After a first edition of the deconvention meetings, held in Paris last March, following the rejection of an increase in the fees for medical consultations, there were already almost 400 contracted doctors who had promised to separate themselves from health insurance.
As a reminder, some of the contracted doctors wanted the fees for visits to increase from 25 to 50 euros. In the end they will only get a 1.5 euro raise from social security, which has led to general anger in the profession.
What is the convention?
The medical agreement is a contract that binds doctors to health insurance. This contract covers the administrative processes, fixes the prices of the consultations according to the specialty of the doctor, but also the reimbursement procedures. These recognized doctors are part of sector 1. For example, a recognized general practitioner receives €26.50 per consultation.
Doctors in sector 2, also known as the “free-fee affiliated sector”, concerns the fixed fees freely chosen by the healthcare professional. Use the basic rate of the agreement, increased by an increase fixed by the doctor which corresponds to an overrun.
Non-contracted doctors choose to break this contract with the Social Security. They then move on to sector 3. They are then free to set their own viewing fees. Proponents also point to the saving of time on administrative procedures.
According to the latest health insurance data at the end of 2021, cited by The Parisianonly 572 general practitioners do not adhere to the agreement and practice sector 3 at a totally free rate compared to 111,381 doctors and specialists having an agreement.
What are the consequences for the patient?
If your GP decides to terminate your contract with Social Security, the difference will be felt.
When a doctor has an agreement in sectors 1 and 2, you are reimbursed up to 70% of the basic price of the consultancy and 30% from your health insurance. For sector 2 professionals, the excess fee is not reimbursed by the health insurance, but can be reimbursed by your supplementary health insurance.
When a doctor does not have an agreement, therefore in sector 3, you are reimbursed only up to €0.61 for general medicine and €1.22 for specialists. Specifically, if your doctor decides to apply a fee of €50, you will only be reimbursed 61 cents.
Of course, the rest can be taken into consideration by your complementary health insurance according to the guarantees in your contract.
The choice can be complicated, especially in the context of a shortage of doctors in France. Either you agree to pay much more for your consultation with your trusted doctor, without being sure that you can be reimbursed in full by your health insurance company, or you change doctors.