Half of health specialists charge above set state rates in France

Gynaecologists, ophthalmologists and anaesthetists were often found to charge more in a study by a leading consumer association

Some cities saw fees twice as high as in rural areas
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More than half of French medical specialists are charging above the standard rates in France, a study has revealed.

Consumer rights group UFC-Que Choisir has published a study showing that 52.8% of French healthcare specialists assessed charge above the standard rate.

This is almost 7% higher than in 2019.

The group said it was one of the reasons for the “soaring cost of healthcare” and urged the healthcare industry to do more to prevent doctors from setting such fees.

However, the study did show that higher fees were disproportionately charged in departments with major cities, and in those around the capital.

Charging above the fixed state rate is permitted, depending on the agreement the doctor has signed with French social security. The extra part of the fee is called dépassements d’honoraires.

Some specialisms especially affected

The study – which you can find here – assessed eight specialists in the healthcare sector, and found that in general gynaecologists are the group most affected.

More than 70% of gynaecologists set their fees above the standard rate, charging around €20 more for an appointment.

This was followed by ophthalmologists (66.7% charge more, on average €13.80 above standard rates), and anaesthetists (58.8% charge more, on average €10.90 above standard rates).

Appointments in larger cities could cost “more than twice as much” as those in rural departments.

For example, in 17 departments – mostly rural, in the centre of France – anaesthetists charge the standard rate, which is €30.

However in five departments, mostly in Île-de-France, the cost is at least €50 for any appointment.

Read more: How does your local French hospital fare in official quality rankings?

Why are fees high?

Specialists can be part of one of three ‘sectors’ in France, which defines how they are able to set their fees.

Doctors in sector 1 charge the standard rate for treatment set by social security (Assurance Maladie) in their field.

Sector 2 doctors have a contract with the social security system but can charge more though they are meant to do so with ‘moderation’, finally sector 3 doctors are non-contracted and are completely free to set their own rates.

In addition, the state reimbursement for seeing a sector 2 doctor is usually slightly lower than for a sector 1, though a good ‘top-up’ healthcare policy may help to avoid or reduce any difference in the actual cost to the patient.

UFC-Que Choisir is recommending however that newly-qualified doctors should need to spend a certain amount of time working at sector 1 rates before looking to move to sector 2.

If they join sector 2, it says, they should only be allowed to join if they adhere to the ‘Optam’ scheme for sector 2 doctors, which sets specific limits to their dépassements d’honoraires and allows their patients a better state reimbursement.

A 2023 study by the same group found that in the poorest households, almost one in two people have found access to healthcare difficult, primarily because of the cost.

In addition, 38% of people said they gave up on seeking a treatment of some kind because they could not afford it.

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