€1 franchise fee proposed for medical devices in France
Adding the fee could save the state at least €259 million in healthcare costs, a new report claims
Charging a €1 franchise médicale fee could save the state at least €259 million per year, a new report states
Copyright (c) 2016 M2K7/Shutterstock. No use without permission.
Medical devices in France could be subject to a €1 franchise fee under a new proposal.
The plan was part of a report submitted to the French government. It calculates that the fee could save the state at least €259 million per year in healthcare costs.
Unlike medicines, medical consultations and medical transport - which are all subject to a franchise fee - medical devices are currently exempt from such a charge.
A medical device, or a dispositif médical in French, is defined as any instrument, equipment or product intended for medical use that does not have a direct biological effect on the user, such as glasses, hearing aids, crutches, hip replacements, crowns, cardiovascular implants, etc.
Read also: What is France’s ‘franchise médicale’ fee?
The spending review report, from the Inspection générale des finances (IGF) and the Inspection générale des affaires sociales (Igas), calculates that introducing such a €1 fee would generate savings of €259 million per year, if capped to €50 per person per year.
If the cap was also extended to the franchise charged for medicines, savings could rise to €380 million per year.
The report was drawn up at the request of former Prime Minister Gabriel Attal, when he was looking for ways that the government could save money in the draft Social Security budget for 2025.
Read also: Medicines in France will cost patients more from spring
The report sets out scenarios for achieving savings of up to €1 billion by 2027 (of which €500 million from 2025).
France’s health insurance system spends €14 billion on medical devices each year.
This expenditure rose by €2.4 billion from 2017 to 2022 (a rise of 3.7% per year, and 20% overall), the report adds.
It recommends that “all possible levers” be used to reduce costs, including:
Controlling user participation
Controlling prices and tariffs
Controlling volumes bought.
“Controlling volumes consumed appears to be the most effective way of controlling expenditure in the medium term, (but) it is also the most complex to implement,” the report states, adding that introducing a €1 franchise would enable rapid savings to be made.
‘Impact on households is low’
However, the franchise is a hotly-contested subject.
Last year, the government spent months deliberating whether to double the fee on medicines and consultations, after much opposition from doctor and patient unions. Former PM Elisabeth Borne’s government did not make any changes as a result, but Gabriel Attal’s government implemented the move.
The report authors acknowledged that the subject is sensitive. Anticipating backlash to their proposal, they wrote: “The impact on households of a franchise on medical devices is low, and will affect people less than the existing fee.”
The report shows that introducing a €1 fee, with a maximum of €50 per year, would result in an out-of-pocket expense of less than €5 for 65% of eligible people who use medical devices. Only 9% would reach the cap, it estimates.
The report is simply a proposal to the government and would need to be voted through by the government in order for it to be put in place.
What is the franchise médicale?
The franchise médicale is part of the cost of prescribed medication, treatments such as a physiotherapy or speech therapy session, or a medical transport trip (however, the latter is charged at €2 per trip rather than the €0.50 for other items).
Introduced in 2008, the franchise is part of medical costs paid for by the patient, where applicable, for medicines that are otherwise reimbursed by the French state.
It is charged by your caisse primaire d'assurance maladie (Cpam) and deducted from the amount reimbursed by the state. It does not affect the overall price that you pay at the pharmacy or healthcare facility.
Where upfront payment is not required (as is often the case for medicines) then the Cpam will take it off the next reimbursement you receive for a medical service for which you have to hand over money, such as a visit to a doctor.
It is not charged for medicine given during hospital treatment, paramedic care, or emergencies. It also only applies to services prescribed to people aged 18 and over.
For example, you buy a box of medicine that costs €10, which is reimbursed at 65% by the Assurance maladie.
You receive €6 back, not the full 65% (€6.50) because €0.50 is a franchise médicale charge.
You can see your franchise médicale charges itemised in your Assurance maladie online account at Ameli.fr.
Currently, the charges are capped at €50 per patient per year. They cannot cost more than €2 per day per treatment session, or €4 per day for medical transport (one return journey, costing €2 each way).
They are not usually reimbursed by top-up health insurance policies.
Read also: How are you reimbursed for your medicines in France?
