2023-12-18 06:10:00
The French are going to the doctor like never before. In 2022, the number of consultations with the general practitioner increased by 3.8%. Without knowing it, patients benefit from a system born more than fifty years ago – the national medical convention of Health Insurance – which sets a uniform price throughout the territory. Price which gives the right to a refund. “The policy of controlling the prices of consultations, intended to allow access to care for most citizens, has transformed into a means of controlling health spending,” explains Patrice Diot, dean of the Faculty of Medicine of Tours. (Indre-et-Loire).
The so-called approved doctors, sector 1, simply undertake to respect the terms – and therefore the prices – of the agreement. In return, the patient, in addition to benefiting from the lowest price (for example, 26.50 euros for a consultation with a general practitioner), is reimbursed by Social Security up to 70%, the rest is reimbursed by the mutual.
Sector 2 is reserved for specialists
Faced with the demands of certain doctors, sector 2 was set up in 1980, in order to allow those who wish to do so to exceed fees without being subject to restrictions. They therefore also sign an agreement, which authorizes them to exceed fees with tact and moderation. For patients, this is an additional financial burden because their fees are reimbursed on the basis of sector 1. Reimbursement of the excess can, however, be supplemented by the mutual insurance company. Please note, only specialists have access to sector 2.
In sector 3, finally, it’s very simple: doctors have not signed an agreement with Health Insurance. They are independent, free to charge the prices they want, after having informed their patient in advance if the consultation exceeds 70 euros. Patients are not reimbursed, apart from 61 cents for a consultation with the general practitioner, and 1.22 euros with the specialist. Only prescriptions are reimbursed, and they must follow current good practice recommendations.
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