four questions on the “rabbit tax” wanted by Gabriel Attal

This measure, which does not convince health professionals, should allow, according to the Prime Minister, to recover 15 to 20 million slots each year.

One way, according to the Prime Minister, to “respond to a major concern of the French: the ability to find an appointment within acceptable deadlines”. Gabriel Attal clarified, on Saturday April 6, to several regional press dailies, the outlines of a “rabbit tax” which will consist of charging 5 euros in the event of absence from a doctor’s appointment. With this penalty, the government hopes to free up millions of slots lost each year and make patients responsible.

Already announced in his general policy speech in January, the “rabbit tax” is part of a series of measures intended to facilitate access to city care.

1 What is the “rabbit tax”?

On January 30 at the National Assembly, Gabriel Attal presented during his general policy speech the outlines of a measure based on a “simple principle”. “QWhen you have a doctor’s appointment and you don’t come without warning, you pay.”declared the head of government.

Absent from public debate since, the proposal reappears among the series of measures announced by Gabriel Attal on Saturday to respond to the crisis in the healthcare system. The tenant of Matignon sees in this “rabbit tax”, “an accountability mechanism” patients. According to him, increasing absenteeism hampers the effectiveness of the health system.

The principle of this tax had already been proposed and voted on by the Senate, on first reading of the Social Security financing bill (PLFSS) for 2024, recalls Public Senate. The amendment was rejected by the Assembly and deleted from the final version of the text, adopted using article 49.3 last December.

2 How will this “tax” work?

The former Minister of National Education clarified that this tax will remain in the hands of the doctor. He may decide not to apply it if he judges the patient’s reasons to be valid. Otherwise, 5 euros may be withheld from patients who do not keep an appointment or cancel it less than 24 hours in advance. If it is introduced, this penalty will be collected via the banking imprint by appointment booking platforms such as Doctolib or by caregivers themselves in the event of booking an appointment directly.

According to the media La Lettre (formerly Letter A), the Doctolib platform makes “lobbying” in favor of this measure, which “offers the opportunity to establish itself as a health insurance partner and increase its customer base”.

3 Do we know how many appointments are not honored in France each year?

The objective of the “rabbit tax” is to recover 15 to 20 million annual consultation slots, according to Gabriel Attal. But no solid national assessment of the phenomenon exists. Only studies with small samples were carried out and served as a basis for extrapolations.

In January 2023, the National Order of Physicians and the Academy of Medicine estimated – citing without detailing them “several investigations” – that “each week, 6 to 10% of patients do not show up, which corresponds to a loss of consultation time of almost two hours per week (…), almost 27 million appointments per year”, all disciplines combined. This estimate is based mainly on a survey carried out by the Regional Union of Health Professionals (URPS) of Ile-de-France, notes The world. This is an extrapolation from the responses of just over 2,000 doctors to a multiple choice question.

The general practitioners’ union MG France conducted its own survey on the responses of a thousand of its members. “If we extrapolate, it’s around 6.5 million ‘rabbits’ per year that we deplore”or 2% of “251 million procedures carried out each year by general practitioners”concludes the organization.

For its part, the medical appointment booking platform Doctolib communicated in February 2023 on the figures at its disposal. “All specialties combined, among professional users of Doctolib, 4.1% of appointments are not honored, in the strict sense of the term. says the company. Dentists are the most affected, according to the same source.

4 How do users and health professionals react?

The president of France assos santé, Gérard Raymond, strongly criticized the position of the head of government on Sunday on Franceinfo. This tax is not a measure of “patient responsibility”but an attempt to “guilt”, according to him. Gérard Raymond says to himself “more opposed than ever” to this tax because, according to him, the practitioner “will look at the end of the month and say: ‘I’m short a few pennies, so I’m going to make ‘rabbit’ declarations”.

On the side of caregivers, the introduction of this tax does not arouse enthusiasm either. On BFMTV, Jean-Paul Hamon, general practitioner and honorary president of the Federation of Doctors of France (FMF), attributes the increase in patient absenteeism to the growing weight taken by Doctolib in the French healthcare system. “The ‘rabbit tax’ is the State which rolled out the red carpet for Doctolib, which never refuses a patient who poses ‘rabbits’ (…) We reap what we sow.”

The platform, like the websites of certain medical practices, however, already offers other options to reduce the risk of “rabbit”. Reminders by SMS and email “can reduce up to 60%” consultations not honored, believes Doctolib. The platform offers doctors the ability to monitor their patients’ attendance and “block online appointment booking for (…) repeat offenders”.

“Me, if a patient has a habit of not honoring his appointments, I exclude him from my patient base”also explained Sunday morning Luc Duquesnel, president of the general practitioner branch of the Confederation of French Medical Unions, on franceinfo.