9. Medical Consultants/Specialists in France
9.1. How to see a Consultant/Specialist
Most consultants are self-employed, although many public hospital consultants are salaried.
Some may be working in their own, others in a private clinic and still others in a public hospital.
This does not necessarily affect the amount you will have to pay, as there is no distinction between the private and public health sectors in the same way as occurs in the UK. That part of the health system that is truly 'private' (non-conventionée) is very small.
If you need to see a consultant then your doctor will provide you with a letter of referral.
You are likely to find that French GPs do not hesitate to refer you on for a more specialist assessment if your circumstances are more than routine.
Your doctor may recommend a suitable consultant, but you are not obliged to accept their recommendation. If you have someone else you would rather see then the choice is yours.
There are two circumstances when you are entitled to see directly certain consultants without having to pass through your doctor, and without financial penalty.
If you need to see a gynecologist or ophthalmologist you can go direct. Likewise those under 26 years of age are allowed to see a psychiatrist, without the need to first go through their doctor.
Similarly, where you need to see a specialist as a matter of urgency then you may go direct without financial penalty. Such circumstances might occur, for instance, where you are away from home and you are taken seriously ill.
You are normally expected to make your own appointment with the consultant but if you need assistance your doctor may well make the appointment for you.
The consultant will advise you of the results of your examination, which will also be communicated to your doctor. Depending on the results if you require further consultations or treatment from the consultant there is no need to be again referred by your GP.
9.2. Fees and Charges
The government sets the official tariffs that can be charged by consultants.
However, many regulated tariffs and low, as a result of which most have been granted the right to charge fees in excess of the official rate, which are not reimbursed by the social security system.
These excess charges are called dépassements d’honoraires.
The excess charges may be reimbursed by your voluntary health 'top-up' insurer, but it will depend on the terms of your contract and the option for full reimbursement is not always available.
Thus, if you go direct to a consultant without passing through your doctor the excess charge will not be met by your voluntary insurer. You will also receive a substantially lower level of reimbursement from the social security system. This does not apply in the instances stated above.
Even if they are not reimbursed you will find that, as a general rule, the excess charge is not substantial for routine consultations – expect to pay between €5 and €30 over the official rate. However, beyond a routine consultation the charges for subsequent treatment can become a lot higher than the official rate.
Consultants and specialists who charge only the official rate operate as fully integrated health service professionals in what is called Secteur 1. Although most GPs operate on this basis, the numbers are going down and the percentage of specialists in this group is far lower. In some areas of France the majority of consultants actually operate outside of Secteur 1.
Those doctors who do not operate as fully integrated professionals operate in what is known as Secteur 2. These health professionals are part of the health service but have been given the right to impose their own ‘reasonable’ charges.
Some specialists have agreed to operate the official rates on condition that the patient is referred to them by their doctor; where the patient is not referred then an excess charge will normally be applied.
Those who operate on a completely private basis (and there are only a very small minority) are called non-conventionnés. Medical professionals in this sector are completely free to set their own charges.
Doctors and specialists are required by law to display their charges and charging policy. If you are not clear, ask them.
Beyond the unregulated tariffs, if you receive medical treatment costing in excess of €120 (2019) at the official rate you pay a contribution of €24 towards the cost of the treatment instead of reimbursement at the standard percentage rate.
This charge is called the participation forfaitaire.
Below the threshold, then reimbursement by the social security system is at the rate of 80% for hospital treatment, leaving 20% to be picked up by your voluntary health insurer, or directly by you if you do not have such a policy. Outside of hospital treatment the rate of reimbursement is 70%.
The charge is applied for any single medical treatment or for multiple medical acts during the same consultation, where the total charge is more than €120.
If you are hospitalised, then the charge is applied only once for any single admission.
As might be expected in France, things are never entirely clear cut, as there are a number of important exonerations from this charge for certain types of treatment and for certain groups of persons, whose costs will be reimbursed at the rate of 100%.
Those exonerations by treatment are:
X rays or scans; Certain laboratory tests; Emergency transport to hospital; Long term hospital care (over 31 days).
Those groups who receive exoneration are:
Long term/major illness (ALD); Treatment for sterility; Pregnant women (last three months); Newly born children (first 30 days); Recipients of invalidity benefits/pensions; Suffering from work related illness/accident; Recipients of complémentaire santé solidaire sans participation financière. Residents of Alsace-Moselle
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