Negotiations between liberal doctors and Health Insurance ended in failure on Tuesday evening. La Sécu proposed an increase in the price of consultations for general practitioners to 26.50 euros, instead of 25 euros, but this is not enough for the unions and collectives of doctors.
>> Fees for medical consultations: why the negotiations fell through
Anticipating this failure, the Minister of Health François Braun wanted to remind France Inter on Monday that “this 25 euros, this 26.50 euros, is not at all the value of the consultation. A doctor has more than 20% of his income which is made up of fixed prices, which makes a basic consultation today at 36.50 euros”. And indeed, the doctors perceive more than the simple price of the consultation that we know.
Doctors receive several remunerations
In truth, the price of 25 euros which is often debated is the price of a basic consultation by a general practitioner installed in liberal. But several packages are added to it, paid for by health insurance. For example, the caregiver earns six euros more for the follow-up of a child under 6 years old, 42 euros more for a patient aged 80 or over. This corresponds to the attending physician patient package.
There is also a package for patients with long-term illness, another for home visits, another for the prescription of certain drugs that are cheaper for Social Security, or even another for the modernization of the medical practice. Finally, they are paid if they meet public health objectives, particularly in terms of prevention, if they vaccinate against the flu or screen for cancer.
All these packages represent well over 20% of doctors’ income, according to a Social Security report on the performance-based payment of private doctors in 2014.
35 euros per consultation on average currently
According to the group Doctors for tomorrow, at the origin of the strike movement of general practitioners last fall, by adding up all these packages, the consultation is paid on average up to 35 euros. By giving this figure, the collective, which is asking for a consultation at 50 euros, hopes to convince that the increase claimed is not so high and that it can be partly paid for by mutual insurance companies, and not by social security, which uses public money.
In his calculation, the Minister of Health has already integrated the increase of 1.50 euro proposed by Health Insurance, which leads him to speak of a consultation paid up to 36.50 euros.
Nearly half goes to expenses
With the current remuneration of 35 euros on average per consultation, at the rate of 5,000 appointments on average per year, according to the majority union of doctors MG France, this amounts to a turnover of 175,000 euros per year and per doctor.
But professionals don’t keep all that money. Almost half goes to the various charges to be paid, according to a report by the Department of Research, Studies, Evaluation and Statistics of the Ministry of Health dating from 2001, in electricity bills, in rent for the medical office, in the salary of their secretary, in medical or office equipment or in refueling to be able to move to patients. Ultimately, GPs receive an average of 92,000 euros per year, according to DREES.
Moreover, what the minister François Braun did not say on France Inter, it is that, precisely, Doctors for tomorrow asks for the abolition of some of these fixed prices in exchange for the increase in the tariff of the consultations. He deplores, through these fixed prices, a kind of disguised wage-earning of the generalists nevertheless installed in liberal. Packages “binding, unethical, unverifiable and, at times, absurd”in the eyes of the collective which represents more than 17,000 doctors.