4,500 doctors have a private activity at the hospital

Professor Laurent Lantieri, the surgeon who successfully completed the first full face transplant, would be subject to an administrative investigation. The reason ? The head of the plastic surgery department at the Georges Pompidou European Hospital (HEGP) would have continued to operate on people in the context of private consultations when he was prohibited from doing so, according to the daily Le Parisien. Indeed, Professor Lantieri had seen his private activities suspended between April and July 2013 after refusing to pay the fee he owed to the hospital between 2008 and 2011.

According to the daily, this investigation was carried out by the Minister of Health, Marisol Touraine, after a patient complaint. The latter affirms that one of the doctors of the service would have asked him for “black money”. The General Inspectorate of Social Affairs (IGAS) was therefore mandated to verify these serious accusations. It was at the request of Martin Hirsch, the new boss of Assistance Publique-Hôpitaux de Paris (AP-HP) that the IGAS investigation was carried out by Marisol Touraine. It is true that, upon taking office in November 2013, Martin Hirsch recalled that he wanted to curb liberal activity in the AP-HP.

4,500 doctors have a private activity at the hospital
This activity is not prohibited. Since the 1958 reform, hospital doctors who work full time can have a liberal activity. The legislator thus allowed the hospital to keep in its fold renowned practitioners who could have been attracted by a purely private activity. Doctors can then choose to apply the health insurance rates (sector 1) or to add additional fees (sector 2). According to the National Health Insurance Fund, more than 4,500 hospital workers had a liberal activity in the hospital in 2011, and 40% of them chose sector 2.

A supervised activity
But beware, this liberal activity is supposed to be carried out according to a very strict framework. First of all, the duration of the liberal activity must not exceed 20% of the duration of the weekly hospital service to which the practitioners are bound. The number of consultations and acts carried out in connection with liberal activity must also remain lower than that of consultations and acts carried out under public activity. In addition, no bed or medical-technical facility can be dedicated to the exercise of liberal activity.

Liberal activity is subject to authorization from the Regional Health Agency. And, the hospital charges a fee for this activity. The fee is calculated as a percentage of the rates set by the health insurance funds. Thus, the public establishment can collect 25% of the tariffs for a private consultation, 40% for acts of surgery, obstetrics or anesthesia, and 60% for acts of imaging or chemotherapy.

8 million euros collected by the AP-HP
The practitioners declare each quarter to their administration the consultations and acts carried out in private, as well as the fees received. Overall, this fee represents a not insignificant sum for public establishments. Thus, the AP-HP received 7.8 million euros in 2011. And according to the central commission of the liberal activity of the AP-HP (CCLA), this global fee increased by 16% between 2009 and 2011.

For their part, the 331 authorized AP-HP doctors received 31.3 million euros in fees. The average annual fees were 94,400 euros. This average masks a great disparity in practices since the CCLA noted that the minimum income is 240 euros and the maximum is 500,000 euros …

Inform patients
Last important obligation for doctors: inform patients in advance of their rates in the liberal sector. Fees and overruns must be posted in the waiting room. And, an estimate is mandatory when the amount of the overrun exceeds 70 euros. An obligation not always well respected, in particular at the HEGP where Professor Laurent Lantieri practices, since the CCLA noted that out of 32 practitioners authorized to engage in liberal activity, only three displayed information in accordance with the regulations.