GPs respect their tariff

In 2006, the average annual fees for a general practitioner were 127,000 euros. For specialists, the average is 235,000 euros. “Of course, it is not a question of net income”, specifies Dominique Polton, director of studies and statistics at the national fund. “The overall amount of fees collected by doctors increased by 3.3% per year on average between 2004 and 2006, against 4.2% over the period 2000-2004”.

This trend is also confirmed on the side of fee overruns. However, a collective which brings together 32 patient associations, the CISS, is once again relaunching the controversy. He points to sector 2, but not only. “We made a survey of the primary funds,” explains Christian Saout, the president of the CISS. And in the light of the results received, it appears that many sector 1 doctors practice excess fees, sometimes unjustifiably. According to the CISS, the Saône-et-Loire CPAM deplores that 71.5% of the overruns practiced by sector 1 doctors are not authorized.
The CISS survey is based only on 9 CPAMs. The only ones who have agreed to fully respond to the collective’s requests. What about at the national level? “Between 2000 and 2004, overruns increased by 3.7% for general practitioners,” explains Dominique Polton. But over the years 2005-2006 they fell by 6.5% per year ”. For the CNAM, this trend reversal in general medicine corresponds to the absorption of the excess movement launched in 2002 and to the tariff revaluation implemented since 2005. According to health insurance, the controversy has no place. .

“The general practitioners of sector 1 very much respect the opposable tariffs, confirms Frédéric van Roekeghem, director general of the CNAM. The overruns represent less than 1% of the amount of general practitioners’ fees ”. Three-quarters of liberal physicians work in sector 1. And general practitioners authorized to practice excess fees, if we exclude acupuncturists or homeopaths (so-called special-practice physicians), are only 8%. As for sector 2 general practitioners, the overruns represent a quarter of the fees. On the side of specialists in sector 2, health insurance notes a slowdown. “Their average overruns continued to increase but less than over the period 2000-2004, with a growth of 10.4%, they rose to + 4.6% in 2004-2006”, states Dominique Polton. This trend, however, varies according to the departments and specialties. In nephrology, exceedances increased by 28% in 2004-2006, in thoracic and cardiovascular surgery by 18%. In the Haute-Saône department, specialist overrun rates fluctuate between 70% and 105% while the national average is around 50%.

Questions to Frédéric van Roekeghem, director general of the national health insurance fund

Overshoots are a problem for specialists

According to the CISS, are the overruns on the rise among general practitioners?
Frédéric van Roekeghem. We do not observe any upward trend in excess fees for general practitioners. The vast majority of them respect the opposable tariffs set by Social Security. The overruns represent less than 1% of their fees. We note that the number of physicians likely to practice overruns has decreased, and the amount of their overrun has also fallen.

Is it the same for specialists?
RVF This development is not observed in specialized medicine. It’s the opposite. In 1985, the surpassing rate for specialist physicians was 25%, today it is 50%. It is an evolution which dates from the creation of sector 2, poses a certain number of problems of access to care. A structural response must be provided to this situation. We are going to discuss it within the National Union of Health Insurance Funds. Either we find an agreement with health professionals, in particular around an optional sector, or the public authorities will have to take up this issue.

Faced with abuse, what does the CNAM do?
FV R. This question is different. The abuses concern a small number of professionals, who charge prices that are not related to the technical nature of the acts they perform, nor to their skills, or that they do not adjust according to the ability of their patients to honor them. On this issue, we have embarked on a policy of resolute struggle. By filing complaints with the regional councils of the orders of health professionals. We are starting to have case law in this area. I would also like to remind you that the Social Security financing law this year provided for the possibility of financial penalties and that a decree is being drafted at the ministry.
Interview with MG