The consumer organization UFC-Que Choisir wants to restrict fee overruns by new doctors, arguing that there is an “uncontrolled development” of these overruns, which is harmful to access to care. “New doctors should only have the choice between a sector 1 with fees without excess, or the Controlled Pricing Practice Option (Optam)” which allows the excess of fees but in a limited form, indicated Que Choisir in a statement. Furthermore, we must “remove public aid for doctors” who exceed fees outside Optam, she said. On the other hand, “Social Security must (…) reach a conventional agreement on a basic rate acceptable to independent doctors,” she added.
Access to care is one of the hobbyhorses of the consumer association, which has just filed an appeal for “inaction” in the matter against the government, before the Council of State. Que Choisir wants new doctors to no longer be able to access “sector 2”, which allows them to charge their patients more than the conventional rate. Social Security only reimburses these consultations on the basis of the conventional rate, it is up to supplementary health insurance to be completed, fully or not depending on the patient’s coverage.
Que Choisir supports its criticism of fee overruns with a study on three specialties (gynecology, pediatrics, ophthalmology), which shows that the prices of doctors’ consultations in sector 2 tend to be higher and more homogeneous in a given geographical sector , when there are no longer conventional rate doctors present on site.
The presence of doctors billing at the conventional rate “is systematically the factor most strongly and significantly correlated with a reduction in sector 2 rates in this location,” indicates Que Choisir. Conversely, when there are only sector 2 practitioners in a sector, there is rather “an imitation of prices between neighbors” rather than competition, notes the association.
According to statistics from the Ministry of Health, more and more specialists have moved to sector 2, 53% of them in 2022 compared to 42% in 2012. Conversely, the practice is less and less less common among general practitioners, with only 5% using it in 2022 according to the same source. The Controlled Pricing Practice Option (Optam), a form of excess spared by UFC-Que Choisir, allows doctors not to respect conventional fees, except for a portion of their patients who continue to benefit from these prices.