Upfront doctors' fees to be axed

PATIENTS will no longer have to pay upfront to see the doctor from 2017, the government says.

A visit to the doctor would be paid for via tiers-payant, that is, in the same way as when collecting prescribed medicines from the pharmacy.

This could come in by the end of 2014 for people on fairly low incomes who have the ACS benefit to help pay for a top-up mutuelle health policy. (It already applies to people with fully state-reimbursed healthcare on the CMU-C).

The current system
- At the doctor: The patient pays the doctor’s fee then hands over their carte vitale (microchip state health card) which the doctor swipes so a reimbursement is later made to the patient’s bank account.
Where the patient has a mutuelle and has provided its details to their Cpam (local state health insurance body) it automatically repays the “topup” part to the level of the person’s cover under the policy.

- At the pharmacy: The patient hands over their carte vitale and a microchip card for their mutuelle.
Any part of the cost attracting a state reimbursement is not payable by the patient - the pharmacist will be reimbursed directly by the state.
The mutuelle card allows the pharmacist to check the patient’s top-up cover, and, if appropriate, dispense them from payment of remaining amounts as well.

Under the proposals a visit to the doctor would be similar to visiting the pharmacist, ie. with no upfront payment due unless the patient has not a mutuelle or they have one but its cover is insufficient to topup the full price of the bill.

“If the tiers-payant works at pharmacies it should be able to work everywhere else,” said Health Minister Marisol Touraine.
While admitting “a considerable technical challenge” in linking doctors and 400 mutuelles, she said “it will be a major advance for patients.”

Some doctors object to what they see as interference from the state.

The union CSMF said the system must not cause “delays and costs”, adding it might encourage patients to go to the doctor more often for minor matters, increasing social security costs.
The union also flagged up the €1 tax taken off reimbursements for doctor visits, and the franchises tax levied on each box of medicines.

At present, where a person does not pay upfront for medicines, franchises are deducted from other reimbursements due from the Cpam, such as for money paid to doctors.

The CSMF said: “We warn the government it’ll have to manage to collect them by some other means than the doctors acting as intermediaries.”

Leading GPs’ union MG France, however, pronounced in favour, saying this might encourage more people to go to their GP instead of abusing A&E departments where they are already entitled to be seen without paying up front.

- Mutuelle premiums should rise by no more than 2.5-3% on average in 2014, says the president of industry body La Mutualité Française.
This is because no new cuts to state reimbursement of medicines or new taxes on mutuelles are planned.