Visit the doctor: what is the “rabbit tax” and how does it impact you?

in collaboration with

Dr Gérald Kierzek (Medical Director)

“When you have a doctor’s appointment and you don’t come, without warning: you pay!”. In his general policy speech given on Tuesday, January 30, Prime Minister Gabriel Attal relaunched the solution of financial sanctions, to avoid last-hour withdrawals which result in losses “millions of hours” not replaced by doctors.

A tax to make absent patients responsible

The financial penalty is not new. Senators have already wanted to include this sanction when examining the Social Security budget in 2024 in the face of missed appointments. According to figures from the Academy of Medicine and the Order of Physicians, 6 and 10% of policyholders do not show up for their medical appointments. This represents two hours of consultation lost per week for professionals, whatever the discipline. Gabriel Attal’s idea is therefore to make patients who do not honor a medical appointment responsible by making them pay for the consultation. A sanction nicknamed the “rabbit tax”.

For the moment, however, nothing has been decided on how this penalty would be recovered. “Will the doctor be able to deduct this missed appointment from a future consultation? Will the fund pay the doctor? Will she keep this tax? Who will it go to and how will it be managed?” asks Soline Guillaumin, spokesperson for the Doctors for Tomorrow collective on France Info. One solution envisaged would be to deduct the sum, (but what?) from future benefits due to patients. The amount could be set by decree.

A solution far from solving the problem

If the Prime Minister is thus decided to sanction patients for their lack of “courtesy”, basically health professionals are divided. Starting with our medical director, Dr. Gérald Kierzek, who was moved in a sarcastic tweet: “It will solve all the problems: empty the emergency rooms, provide the hospital with resources, restore its attractiveness…”

The priority was probably not what was expected. When questioned, he told us: “Yes there are absences, linked to a problem of education or respect, as well as logistical problems posed by platforms like Doctolib… But from there to making a tax: who affects whom? How ? In my opinion, we will quickly be faced with the impossibility of implementing this and once again, this will only serve to make patients feel a little more guilty.”

The measure, which is now being talked about, would also be a cover for more impactful problems: “Taking an interest in rabbits and the penalization of patients who do not come to their appointments while the problems that the French suffer from are access to care, the difficulty of finding a general practitioner near them to support them over time. It’s quite ridiculous.” protests Jean-Christophe Nogrette, general practitioner and deputy secretary general of MG France on France Info.

A measure which does not convince, therefore.

The Prime Minister’s other “health” announcements

Other announcements concerning health were made by Gabriel Attal on Tuesday evening, to free up daily medicine time.

Restoration of childcare obligations (in certain departments)

Gabriel Attal wishes to restore on-call obligations for private doctors, in departments where this is lacking. “In departments where there is still no access to care service” by next summer, “I am ready to go further, by restoring on-call obligations for private doctors, in the evenings or on weekends, in their offices, in hospitals or in nursing homes”.

The SAS helps relieve emergency congestion by directing people who need a diagnosis or treatment to the most appropriate structure, a hospital or a town doctor.

An “emissary” responsible for recruiting foreign doctors

After Emmanuel Macron’s announcement, Gabriel Attal promised Tuesday to appoint an emissary “responsible for looking abroad for doctors who would like to come and practice in France”. “We must find ways to bring back our young French people who have gone to study abroad,” also estimated the Prime Minister.

He also wishes to better recognize the experience of health personnel already in place. Thus, a “nurse anesthetist, who has a baccalaureate +5, several years of career and experience, must be able, if she wishes, to enter directly at least into the 3rd year of medicine”, he suggested.

A reform of the “My psychological support” system

The “My Psy Support” system did not give the expected results Gabriel Attal wishes to do more. “We are going to increase the price of the reimbursed consultation to limit the out-of-pocket costs for young patients and their families as much as possible.“, promised the Prime Minister. He also wants to allow young people to have direct access to a psychologist, without necessarily going through a doctor.

A bonus and a salary increase for school nurses

The Prime Minister announced a salary increase and an exceptional bonus for school nurses. They will receive a bonus of 800 euros in May, from which date their salary will be increased by 200 euros net per month.

A reform of state medical aid before the summer

Gabriel Attal finally wishes to commit to the reform of state medical aid (AME) promised by Elisabeth Borne during negotiations on the immigration bill. This document issued in December 2023 concluded that the AME, which provides full coverage of health costs for foreigners in an irregular situation present in France for at least three months and subject to resource conditions, is a system “generally controlled”but who “worth adapting”.