French surgeons and specialists are calling for significant changes to the country’s healthcare reimbursement system, arguing that current structures force them to charge patients additional fees to cover the gap between what they are paid by the national health insurance system (Assurance Maladie) and the actual cost of providing care. The situation has led to discontent within the medical community, including a symbolic protest in Brussels and a recent demonstration in Paris.
The Issue of “Fee Overruns”
At the heart of the dispute are “fee overruns” – charges billed to patients above the rates approved by Assurance Maladie. Several recent reports have highlighted the increasing prevalence of these overruns, prompting discussion of potential taxes on such charges, a proposal that was ultimately rejected by the government. Surgeons, anesthetists and obstetrician-gynecologists contend that they are often left with no alternative but to bill patients directly for these additional fees due to the low reimbursement rates offered by the state insurer.
Philippe Cuq, of the Union of Surgeons of France, explained that these overruns are “almost obligatory to be able to ensure our economic balance.” He argues that the specialties represented by “Le Bloc” – the group of concerned doctors – face unique financial pressures, including the high costs associated with operating room access and the need for expensive malpractice insurance.
France’s Sector System and Reimbursement
France’s healthcare system categorizes doctors into three sectors, impacting both the fees they can charge and the level of reimbursement patients receive. Doctors in Sector 1 have a full agreement with Assurance Maladie, while those in Sector 2 have a partial agreement. Doctors in Sector 3, often referred to as “non-conventionné,” do not have an agreement with the state insurer and can charge higher fees, but patients receive lower reimbursement rates.
The current system, as it stands, can create financial strain for both doctors and patients. While France’s medical system is comprehensive, navigating the reimbursement process and understanding the implications of each sector can be confusing, particularly for newcomers.
Proposed Solutions: A “Single Sector” and Revised Rates
The surgeons’ unions are advocating for a radical overhaul of the system, proposing the creation of a “single sector” where all practitioners would be better compensated by Assurance Maladie, particularly for procedures where overruns are common. As an example, they suggest that a uterine removal surgery, currently reimbursed at around €350, should be covered by Social Security at approximately €630. They also propose annual reviews of these rates to account for inflation in professional costs.
However, this proposal raises concerns about the financial implications for Social Security, which is already facing a projected deficit exceeding €20 billion this year. The unions have not yet provided a detailed cost analysis of their plan.
In the interim, the unions have requested a review of the rules governing Sector 2 and the Optam system, which limits the amount doctors can charge above the standard rates. They are pushing for the elimination of these regulations.
Impact on Insurers and Future Negotiations
The proposed changes also have implications for private health insurance companies (mutuelles). The surgeons’ unions suggest that insurers should be required to reimburse at least a portion of the overruns billed for anesthesia, surgery, and obstetrics procedures, aiming to reduce the financial burden on patients. This comes as the government is already re-evaluating the roles and responsibilities of both Assurance Maladie and private insurers in covering healthcare costs.
The director of Health Insurance, Thomas Fatôme, has acknowledged receiving the unions’ demands and indicated a willingness to explore potential negotiation frameworks. However, he cautioned that a period of discussion and evaluation is needed before any concrete steps can be taken. “We have to let the requests and exchanges settle a little,” he stated.
The situation highlights ongoing tensions within the French healthcare system, as medical professionals seek fair compensation for their services while policymakers grapple with the challenge of maintaining financial sustainability and ensuring equitable access to care. The outcome of these negotiations will likely have a significant impact on both patients and providers in the years to come. While the unions hope for a resolution before the upcoming presidential election, the path forward remains uncertain.
