It is a trend that is confirmed and accelerated. According to the latest report of the High Council for the future of Health Insurance (HCAAM), the total amount of rates exceeding specialized doctors reached 4.3 billion euros in 2024. An increase of 5% per year since 2019 in real value, excluding inflation.
Doctors apply the exception of rates (not reimbursed compared to basic health insurance prices), very often specialized, registered in sector 2, which is “approved”, does not authorize this.
However, as the report points out, the number of professionals registered in sector 2 continues to progress in France.
It should be said that “today’s excessive rates represent more than third -party professional income for certain specialties,” says the report. But with strong disparities.
A financial problem for specialists
“Overviews represent most of the income in certain specialties whose income is lower on average, while they have a much lower place in the revenues of certain already intensive technical capital specialties, whose income is the highest,” said Hcaam.
Choosing sector 2 and applying “high” excesses is to offer the possibility that doctors have less volume work, estimates the report and establish in geographical areas where income is comfortable.
“We observe, for all specialties, that professionals who apply the highest excesses have a smaller activity than their colleagues. The possibility of applying high excess rates facilitates installation at a high level of living rooms, where, in fact, the proportion of specialists in sector 2 is much greater.”
It is not enough to reduce the problem of medical deserts, on the contrary. “Excessive rates, therefore, contribute to aggravating territorial inequalities in the distribution of specialists,” you can read.
The temptation to establish themselves in the richest areas
On the patient’s side, the generalization of specialists not overcome mechanically leads to an increase in the rest of the Social Security.
“For example, for a total hip prosthesis intervention, almost half of the patients pay excesses (630 euros on average and more than 1,000 euros in 10% of cases). Also in the complete episode of care that surrounds this intervention, almost 80% of patients are exposed to at least one advance. In the report of 700 euros on average and more than 1,400 euros for 10% of patients.”
Because if the excessive rates of doctors are served around 40% for complementary health, they represent a total of 14% of households.
The HCAAM remembers that the most modest households covered by the health of complementary solidarity (C2S) are protected in theory against excesses, since professionals have the prohibition of billing this surplus.
“But the effectiveness of this protection is attenuated by the fact that many insured people do not affirm their rights,” reads.
“For other insured persons, even in long -term affection (ALD), complementary health management is variable depending on the type of contract and rarely integral. Company’s contracts, which mainly cover employees in the private sector and their owners offer generally higher guarantees than individual contracts, more frequent among older people and not implemented,” explains the report.
“Misunderstandings against a barely readable system”
Obviously, the more the insured in a large city lives where income is easy (where specialists in sector 2 are the most numerous), the more it exposes excesses. The patient overcoming is, therefore, four times greater in Paris than in the national average.
In the same way, the greater the insured, the more you will have to pay excess, your need for specialized professionals to be more important. The 70-79-year-old pays twice as much excesses than 30-39 years.
“The excesses of rates are variable, not predictable and awaken in many patients a misunderstanding in front of a barely readable system. Three quarters of the population that lives in France believes that excessive rates practiced by certain doctors are not justified.”
Source: BFM TV
