After a consultation, it happens that the credit card heats up more than expected. And for good reason: more than half of specialist doctors charge excess fees, according to the consumer association UFC What to Choose, which denounces, this Thursday, February 22, “the soaring cost of care” and its consequences on the health of the most modest.
According to the association, which compiled Health Insurance data, 52.2% of independent specialist doctors applied excess fees in 2021, compared to 45.8% five years earlier. Of the eight specialties taken into account in the study, gynecology is the one which practices the most excesses, with 71.4% of the practitioners concerned. The average excess for gynecologists is 20.60 euros, on a basic consultation set at 30 euros (2022 figures).
| Specialists | Average price | Average excess (in France) | Average price (most expensive department) | Average overrun (most expensive department) |
|---|---|---|---|---|
| Anesthetists | €40.9 | €10.9 | €59.2 | €29.2 |
| Cardiologists | €55.9 | €4.9 | €77.8 | €26.8 |
| Dermatologists | €41.7 | €11.7 | €70.3 | €40.3 |
| Gastroenterologists | €37.50 | €7.50 | €67.9 | €37.9 |
| Gynecologists | €50.6 | €20.6 | €80.50 | €50.50 |
| Ophthalmologists | €43.8 | €13.8 | €65.5 | €35.50 |
| Pediatricians (0-2 years) | €46.2 | €9.2 | €66.7 | €29.7 |
| Psychiatrists | €63.9 | €13.7 | €83.6 | €33.4 |
Source : UFC-Que Choisir, based on Health Insurance data. Year 2022, mainland France.
Next come ophthalmologists (66.7% above the Health Insurance rate, for an average overrun of 13.80 euros), and anesthesiologists (58.8% are above the Social Security rate, for an average overrun of 13.80 euros). 10.90 euros). But “national averages mask deep territorial inequalities”, underlines Que Choisir, who notes that a consultation can be “up to 2.5 times more expensive from one department to another”.
Generally speaking, Paris is the champion in all categories of overtaking, followed by the rest of Ile-de-France, the southern coastal departments (Alpes-Maritimes and Var in particular) and a few departments with large metropolises. , notably the Rhône and the Bas-Rhin. Among anesthetists, whose prices can vary from one to two across France, the enforceable price of 30 euros is respected in 17 departments, mainly rural. On the other hand, “in five departments (Paris, Hauts-de-Seine, Val-de-Marne, Somme, Haute-Saône), the fees amount to 50 euros or more”, underlines Que Choisir. Note that the coastal departments of the South, and others with large metropolises, are also affected by these high prices.
A consultation with the gynecologist costs on average 80 euros
Among gynecologists, the average price of a consultation in the most expensive department is 80.5 euros, an average excess of 50 euros. Same observation among gastroenterologists where patients in the most expensive department pay on average 67.9 euros for their session with an excess of 37.9 euros. Faced with this growing distance from the conventional rate, Que Choisir is calling for “the closure of access to sector 2 (free fees) for new arrivals”. For cardiologists, Hauts-de-Seine has the highest price, at €77.8, while the Social Security rate is €51. Among the eight specialties examined, cardiology is the one with the lowest fee overruns.
How to explain this? “The most obvious cause of this totally unequal situation is the rapid growth on the part of specialists authorized to bill excesses, visible even on a 5-year scale depending on new installations and retirements,” responds UFC- What to choose. Take the example of anesthetists: the share of practitioners overcharging increased by 12.8% between 2016 and 2021, a figure up 9.9% among pediatricians. And this trend risks getting worse with the numerous retirements of doctors from the baby boom generation.
For the association, new doctors should only be entitled to the new system known as “Optam”, which authorizes fee overruns but under much more controlled conditions than in “sector 2”. The Optam practitioner has in particular the obligation to keep the conventional fees for part of his patients. Furthermore, while private doctors are currently negotiating with Health Insurance, Que Choisir is asking to “condition” a future increase in the conventional price to “the effective reduction of the remainder payable by users”.
Patients “trapped”
According to a exclusive survey of the UFC-Que Choisir Consumer Observatory in November 2023, carried out among a representative sample of 1,004 people, 45% of the lowest-income respondents say they struggle to find medical appointments, compared to only 4 % of wealthiest households. According to this survey, 38% of people who consider themselves to be in poor health give up care for financial reasons.
For all of the eight specialties studied, at least one department has an average price corresponding to the enforceable price (zero average excess); These are generally rural departments and relatively poorly equipped with doctors. This study, according to UFC-Que Choisir, concludes one thing: “Patients tend to reside either in a “geographic desert” (few doctors) or in a financial desert (relatively more numerous doctors, but at very high prices). ), and therefore to be trapped in one way or another.”