France looks to fine people who miss a doctor’s appointment

France looks set to consider fining people who do not show up for doctor appointments, new Prime Minister Gabriel Attal has confirmed.

Speaking in parliament, Mr Attal said that missed medical appointments cost doctors “millions of hours”. “It’s a simple principle: if you have a medical appointment and you do not show up, you will pay,” he said.

An estimated 6-10% of appointments are missed every year, according to figures from the Académie de médecine and the Conseil national de l'ordre des médecins. This equates to 27 million missed appointments that other patients could have used.

Such a penalty has been labelled the ‘taxe lapin’ (‘rabbit tax’) in French. This comes from the phrase ‘poser un lapin’, which means ‘to stand [someone] up’ or fail to show up.

So far Mr Attal has not revealed further details on its implementation.

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Ongoing negotiations

Some doctors and senators have long called for such a measure.

Senator Corinne Imbert (Les Républicains, Charente-Maritime) led the campaign during the most recent social security financing bill, calling for the amount to be “paid directly by the insured [person] to the Assurance maladie, deducted from their bank account, or recovered by the Assurance maladie from future benefits of any kind”.

The government was in favour of the principle but did not reach a decision at the time it was proposed and added it to a list of subjects to discuss with doctors as part of ongoing contract negotiations.

The bill also said that the fine could be paid to doctors for their missed time.

‘Proper use of healthcare services’

In October, the Assurance maladie launched a campaign featuring rabbits (for the ‘taxe lapin’) seeking to raise awareness of “the proper use of healthcare services”. Research suggests that some people in France are not aware of the impact of missed appointments.

One study by research consultancy BVA, carried out for the Assurance maladie, found that most people in France “believe that they make reasonable use of the healthcare system”.

However, statistics show that 42% report at least one of the following in the past 12 months:

• Missing appointments without prior cancellation

• Forgetting to take their carte Vitale for a consultation

• Going straight to emergency without calling 15

• Delaying vaccinations or screening.

Difficulties and criticisms

Repaying doctors for lost time may not be straightforward to implement, however. Article R. 4127-53 of the Code de la santé publique states that doctors can only be paid for “acts performed”. This is also highlighted in the healthcare professionals’ code of ethics.

And patient association group France Assos Santé has also criticised the proposal, saying that it would turn users of the healthcare system into “scapegoats” for a lack of funding.

UK dropped similar plan last year

France is not the only country to suggest such a plan; British Prime Minister Rishi Sunak last year dropped a similar measure in the UK despite the idea being one of his Conservative party leadership campaign pledges.

He had previously said that it is “wrong [that] there are 15 million missed appointments every year” at GPs and hospitals in the country. This did not “value doctors properly” and “also, more importantly, deprived people of care that they urgently need, making them wait unnecessarily long”, he said.

He said that introducing a fine would be a “tough” but effective measure to change people’s behaviour.

However, a Downing Street spokesperson later said that although “the sentiment remains…[the PM] has listened to GPs and health leaders and has acknowledged that now is not the right time to take this policy forward”.

Health bodies including the British Medical Association had also criticised the plan, saying that it would “make matters worse”, and threaten the principle of “free NHS care at the point of need”.

France does not have this same principle, however, and already charges patients for consultations (although the bulk of these payments are later reimbursed by the Assurance maladie).

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