Why do some French GPs charge more than others?

Reader Question: Our doctor has been charging €30 for consultations. I have not felt able to challenge her, given how difficult it is to find a GP. But I see that the price of a GP visit is supposed to be €26.50 and is not supposed to rise to €30 until December.

You are correct in noting that the price of a GP consultation is scheduled to rise from €26.50 to €30 on December 22.

The rise follows long negotiations with doctors’ unions after they went on strike in 2023. Doctors in favour argued that the €26.50 consultation price is not enough to cover their increased operating costs and inflation.

Most of France’s GPs are self employed, and must pay the operating cost of their surgeries themselves. 

Their revenue comes from payments from their patients and/or from reimbursements for consultations from French national health insurers Assurance Maladie.

Most doctors have signed an agreement with Assurance Maladie and in which case are known as conventionné; they can fall under either Secteur 1 or Secteur 2:

• Secteur 1 doctors (both GPs or specialists) charge the standard rate for medical care set by the Assurance Maladie. They can charge more in exceptional circumstances, such as some home visits, in which case the patient - or their top-up insurer - must pay the difference

• Secteur 2 doctors (both GPs or specialists) can charge more than the standard rate for medical care set by the Assurance Maladie. Payment for their care will be paid (or reimbursed) by the Assurance Maladie, with the patient - or their top-up insurer - paying the extra amount, called dépassements.

There is also a third category of doctors, known as Secteur 3 - non conventionné. These doctors (both GPs or specialists) also charge higher rates, however the Assurance Maladie only reimburses patients a derisory €0.61 per consultation with a GP or €1.22 with a specialist.

The reimbursement of prescription drugs is the same, irrespective of the doctors’ secteur.

Doctors are obliged to make it clear which secteur they are in. 

This information is displayed on the Assurance Maladie’s official online search tool here or on the Doctolib search tool here.

They are also obliged to explain the bill if you ask them. It is possible the €30 charge is due to extra care or special patient requirements. 

Note there is also a sub-category of Secteur 1 doctors who have signed an agreement called ‘Optam’, which allows them to practice ‘moderate’ dépassements, so this is another possibility.

Read more: When are doctor fees rising in France and will reimbursement be affected?

Some French GPs charge more than they should

A small minority of GPs charge more than is standard, despite the practice being what is permitted in their secteur. This could be the case with your GP.

Read more: Letters: French GP is charging more than he should for consultation

These overcharges started to appear around the time of the doctors’ strike in 2023 as part of their campaign to increase the reimbursement rate.

Despite unions agreeing to the Assurance Maladie’s proposal of an increased €30 rate starting on December 22, 2024, some doctors have maintained their overcharges, demanding that patients pay the €30 for a consultation. 

Many such doctors are GPs falling under secteur 1.

In 2023, the Assurance Maladie told newspaper Ouest France that these unauthorised overcharges, practised by secteur 1 GPs, concern “less than 2% of them throughout the country”. 

“A few hundred of the 50,000 GPs in practice are charging €30 already, justifying this as a fee overrun ‘for special patient requirements’”.

One such GP, Dr Jean-Brice de Bary from Val-de-Marne, told medical website Allo Docteurs that he had decided to charge more in 2023.

“€25 for a consultation is not enough when you have someone coming in with a little post-it note, a list of four or five points for a medical certificate, a prescription refill, but also the opinion of someone else in the family. So we need time, and that's why I've decided to increase my consultation,” he said.

Such overcharges could lead practitioners to being sanctioned by the Assurance Maladie.

"If the doctor persists, he could be liable to be decertified, which is obviously not what we want,” Assurance Maladie director Thomas Fatôme told Allo Docteurs.

However, since the reimbursement price is scheduled to rise in December, it is unlikely that the Assurance Maladie will apply sanctions against the hundreds of doctors already charging  €30.