It is likely that 20-25% of such acts as scans and even operations are not required, claims Jacques Marceau, the medical expert of the Fondation Concorde which aims to boost France’s prosperity.
He said the estimate is based on information from groups such as the federation of patients’ associations CISS and is, if anything, conservative.
“There are no official figures, but the health regulator HAS has decided to do a study of its own with results expected this year.
“We at the foundation will be making proposals to them, including asking that there should be regular publications on the relevance of healthcare,” Mr Marceau said. Not only are many medical acts unnecessary but he said often such acts spark side effects and chronic symptoms which themselves need treatment, incurring extra costs – and pain for patients.
Among acts which can be ‘unnecessary’ are MRI scans and the removal of the thyroid gland or prostate, he added. For example in the latter case, it has been found that for small growths, a period of observation and controlled diet may see them disappear without surgery.
Part of the problem, he said, is the way hospital doctors are paid ‘per medical act’.
Another factor is that patients are increasingly demanding, especially those who have researched symptoms on the internet. Doctors can feel “pressurised to prescribe a costly, but perhaps useless, examination such as an MRI scan, due to fear of legal action if they don’t.”
Mr Marceau said one improvement would be the widespread prescription of a second medical opinion in cases of serious illnesses – a policy which is common in other countries, such as Germany, but not in France where it is not always reimbursed by mutuelles.
He said: “The doctor would say ‘to reassure you I’m going to prescribe a second opinion from a colleague who is going to look at your case and consolidate my diagnosis and prescription, or if they disagree, we’ll talk again.”
Controversial plans to extend le tiers payant system by November 30 have been put off to 2018 and doctors will now have the option to use it or not, rather than it being obligatory.
Le tiers payant refers to access to healthcare without paying up-front for the state-reimbursed part of fees. It is already available to patients on ‘100%’ cover, such as for care related to designated affections de longue durée, but was due to be generalised next month under the previous government’s plans.
Now Health Minister Agnès Buzyn says it will be an option for doctors – and will come in ‘during 2018’, the delay being due to technical problems.
It was originally planned that patients with top-up mutuelle policies would not have to advance the remaining part of the fee either but, following a Conseil Constitutionnel ruling, it was agreed that offering that element would be optional.
Many doctors oppose the rolling out of le tiers payant, saying it will mean complications and delays in them being paid. They also feel patients value the health service more if they hand over money, even if reimbursed later.