How could ‘no-show’ fees for GP appointments work in France?

A senator in France has suggested that patients should be fined if they miss a doctor’s appointment after figures show that 27 million appointments are missed each year. We look at how likely this is to be introduced and how it could work.

Senator Corinne Imbert, of Charente-Maritime (Nouvelle Aquitaine), suggested a ‘rabbit tax (taxe lapin)’ which would charge people if they miss GP appointments. The phrase ‘poser un lapin’ in French means ‘to stand [someone] up’, as in ‘the doctor is being stood up’ by the patient who fails to show.

The suggestion was made as an amendment to the controversial healthcare Rist law (loi Rist), which began to be debated in the Senate this week.

Why has the idea been introduced?

The idea is to dissuade people from missing appointments and thereby wasting GPs’ time at a time when doctors are under considerable time pressure.

Doctors have already been on strike several times against proposals in the loi Rist.

Read more: Why GPs in France are on strike and will doctor ‘no-shows’ be charged?

In France, 27 million appointments are missed each year, according to figures from the Académie nationale de médecine and the Ordre des médecins.

This equates to 6-10% of patients seen each week.

The idea is not new. The Union française pour une médecine libre (UMFL), a union of independent doctors, has been debating the idea for several years. In the summer of 2022, a petition was launched in favour of the move, which gathered around 10,000 signatures.

How would it work?

The amendment itself does not provide for how the idea would be introduced. In fact, it states: “The conditions and modalities of this system will have to be determined in the framework of the Convention Médicale.”
There have been suggestions that any fines would be taken from patients’ future Assurance maladie reimbursements, rather than charging them separately for specific appointments.

No amount has yet been finalised either. However, France could take inspiration from other countries that already impose fines, such as Germany, which charges €5 for each booked appointment, whether or not the patient actually shows up.

How likely is it to be introduced soon?

It comes after negotiations with health officials over increased fees and other working conditions broke down after two weeks of talks. The profession said in particular that the offer to raise the consultation fee from €25 to €26.50 only was a “provocation”.

GPs – including from the collective Médecins pour Demain – have been calling for a consultation fee to double from €25 to €50 to help pay for better upkeep of surgeries and to hire administrative staff that could give doctors back hours of consultation time per week.

It therefore appears unlikely that the system will actually be implemented although talks in parliament over working conditions are continuing until the end of the month

If adopted, it would also need its own decree to be published in the Journal Officiel, which could delay its introduction further.

“The timing is tight,” admitted Ms Imbert. “However, it puts the idea on the table. There is no doctor who doesn’t suffer from patients not showing up for appointments.”

Another amendment may seek to apply the procedure to other healthcare professionals, not just GPs. One idea is to penalise patients with a symbolic €1 fine in case several appointments are not honoured, as a means to remind people that they must stick to bookings.

The so-called ‘taxe lapin’ would also require a change to the public health code, namely the R.4127-53, which states that “fees may only be claimed for procedures actually carried out, even if they fall within the scope of telemedicine".

This means that currently, GPs cannot charge patients for no-shows, or decline to take bookings from patients who have previously missed appointments.

But at the start of the year, President Emmanuel Macron suggested that he could be open to introducing sanctions for missed appointments.

He said: “Work will be undertaken with l’Assurance maladie to make patients accountable when one or more appointments are not honoured, or when there is abusive recourse to unscheduled care.”

He said that "too much medical time is wasted by an excess of improvisation". For its part, the Assurance maladie said that it was “working on the subject as part of a wider communication campaign on the 'proper use of the health system”.

However, it did not specify no-show penalties as a solution.

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