Doubts Over New French Hospital Charges
Tuesday 03 November 2009
An historic agreement has been reached to control the fees of French hospital consultants, but it is by no means certain patients will benefit from the deal.
Most doctors and consultants in France are self-employed professionals who receive fees on the basis of the treatment they provide to each patient.
The fees they are able to charge for each type of treatment are set by the government.
Some of the scale rates have barely increased in the past twenty years and rarely reflect the true cost of providing the treatment.
As a result, since the early 1980s, the government has allowed some medical professionals to charge fees in excess of these rates, provided they do so with ‘tact and discretion’.
The extra charges are known as dépassements d'honoraires.
The problem has been that these extra charges have to be paid by the patient either directly, or through their complementary French 'top-up' health insurer.
This might not have been such a large problem were it not for the fact that the charges have become the norm amongst a certain consultant groups (notably surgeons), and that around 40% of the complementary health insurance policies do not cover these charges.
The government has threatened to sanction consultants who do not stick to the ‘tact and discretion’ rule, but they have consistently stopped short of an all out war over the issue, probably out of fear of that they might well lose it!
So in order to break the impasse, a deal has now been reached which effectively legitimises the use of dépassements d'honoraires, but on very specific terms.
Broadly speaking, three specialist groups of consultants (surgeons, anaesthetists, and obstetricians) will be able impose the extra charges provided that at least 30% of their consultations take place using the scale rates, and that for the remaining 70% of consultations the fee does not exceed 50% of the scale rate.
As one impact of this change might well be that the income of some consultants would be lower, the government has also offered the carrot of a reduction in their considerable social security charges, in order to try and persuade them to transfer to this new type of contract.
However, the new contract will be made optional, and not all of the trade unions that represent the doctors and consultants have yet to sign up to it!
As a result it is by no means certain just how widespread will be adoption of the new fee structure. Although it may well be attractive to those consultants who do not earn a lot from their higher fee rates, those with higher levels of income may not feel it is in their interest to alter their fees.
French Health Insurers Accept Charges
As part of the agreement, the complementary health insurers have agreed ‘in principle’ that they will pick up the costs of the extra charges for those consultants who sign up to the deal.
If they do so, it will clearly be good news for those whose complementary policy does not currently cover the charges. However, it is bound to impact on the level of insurance premiums, at a time when the insurers are already having to pick up other costs and taxes the government have dumped upon them.
Some forecasts suggest that complementary health insurance contracts will increase by between 7% and 10% next year, and this is before the impact of the new agreement with the consultants has been factored into the equation.
For those patients who do not have complementary insurance, then they may well find greater generalisation of the extra charges, at levels potentially higher than is currently the case.
Consumer groups have protested against the change, arguing that the main problem is that the scale rates from the government need to be substantially increased. But with the French health system already facing a huge deficit each year, the government is clearly trying to craft out ways of keeping everyone happy while minimising the cost to the public purse.
Amongst the other new charges next year is an increase in the forfait hospitalier, a daily hospital charge not picked up by the social security system. This charge increases from €16 to €18 per day. Not everyone will notice the increase as there are a large number of exemptions, and most 'top-up' health insurance policies do pick up the cost, if you have one.
The level of reimbursements on some medicines not considered to be effective is also to be reduced from 35% to 15%, and some complementary 'top-up' health insurers are saying that if the government does not consider them to be of any use, then they will also refuse to cover them in their policies.
Neither does the agreement with the consultants deal with the growing problem of the unequal geographic distribution of medical professionals across the country, with some parts of the country facing a real shortage in doctors and consultants.
The government have previously proposed a series of measures to achieve a greater level of equality across the country, but the issue was not raised during the recent negotiations on fees.
The new agreement is planned to come into operation in 2010.
You can read more in our guide to the French Health Care.