Faced with the gradual spread of excess fees among certain doctors, which have become "hard to bear for a section of the population," a mission entrusted by the Bayrou government to two parliamentarians calls for their "capping," among ten recommendations unveiled on Thursday.
Faced with a now widespread practice among specialists working in private practice, which has an impact on purchasing power and access to care, the former Prime Minister had tasked MPs Yannick Monnet (PCF) and Jean-François Rousset (EPR) in May with taking stock of the situation and making recommendations to inform the debates on the Social Security budget for 2026.
While excess fees "have helped reduce health insurance costs while increasing doctors' salaries," "their gradual spread among specialist doctors is having a detrimental effect on access to care," these elected officials from Allier and Aveyron emphasize in a report of around a hundred pages.
Three-quarters of young specialists setting up practice today charge excess fees, according to a report from the High Council for Health Insurance (HCAAM) in early October, which was concerned about the inflation of these supplements not reimbursed by health insurance.
Fee overruns "are becoming difficult to bear for a portion of the population," constituting "a barrier or even a factor in forgoing care" and accentuating social and territorial inequalities, the two elected officials emphasize. And "they widen the income gap between specialties and between practitioners in the same specialty."
Several attempts at regulation over the past 30 years have not been enough to counter their growth: the total amount of excesses increases each year (4.5 billion euros in 2024) and more and more doctors are setting up in sector 2 (three quarters of new installations in 2024).
In sector 1, doctors apply the tariff set in the national agreement without excess fees, except in exceptional circumstances.
In sector 2, a doctor can charge fees higher than the basic Social Security levels. These excess fees are not covered by Social Security, leaving the insured with a more or less significant out-of-pocket expense.
The 2026 PLFSS provides for an additional contribution on excess fees for liberal practitioners in sector 2.
After examining several scenarios, including a total ban on excess fees, Yannick Monnet and Jean-François Rousset ultimately recommend "a cap" in a "pragmatic approach".
They call for "reducing, or even eliminating" these excess charges "on procedures that are important for the health of the French": a flat rate, or even a ban, on excess charges in the case of repeated procedures and consultations within the framework of a treatment episode or for certain pathologies (such as cancer), and a ban on certain preventive procedures and examinations.
– Role of complementary funds –
The report also suggests agreements with four specialties (surgery, anesthesia, ophthalmology, radiology) representing more than two-thirds of excess fees, to eliminate these excess fees for the most significant procedures, particularly in cancer care.
In the event of excessive overruns, elected officials want sanctions, starting with an annual campaign to monitor doctors working in sector 2.
They are also defending increased compensation for practicing in sector 2 and the possibility of excess fees, via the revision of the nomenclature of technical acts (CCAM).
While doctors' unions are not hostile to public authorities seeking to limit the most blatant excesses in excess fees, they are fiercely defending the principle of this additional income, which they believe allows many practitioners to compensate for an insufficient increase in their fees over the years.
Beyond doctors, the Monnet-Rousset mission considers it "important to ensure that complementary health insurance reimburses them properly." Currently, it is difficult for patients to know what complementary health insurance will actually cover, and some patients are very poorly covered.
The two MPs therefore suggest requiring supplementary health insurance companies to offer their policyholders two options: one without covering excess fees, the other with full coverage.
Another recommendation: to allow more French people to benefit from the Complementary Health Solidarity Scheme (C2S), which protects against excess fees, by raising the resource thresholds for accessing it.
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