The fee for a consultation with a general practitioner registered under Sector 1 was increased from 23 to 25 euros on 1 May 2017. This price increase was decided by the French National Health Insurance Scheme in agreement with doctors’ representatives, following the Medical Agreement of August 2016, with a view to gradually bringing medical fees into line with those in comparable OECD countries. This ‘natural experiment’ makes it possible to carry out an evaluation of the causal impact of an increase in medical fees on a range of indicators relating to the provision of healthcare. The results suggest that the increase in fees had little effect on the frequency with which patients visited their GPs, but that it led the practitioners concerned to see more patients each month, by increasing both the number of patients seen each day and the number of days worked per month. The impact of this measure is particularly pronounced among doctors under the age of 40. There has also been a decline in the average number of prescriptions per patient following the fee increase. Whilst the measure has certainly cost the National Health Insurance scheme more, this additional expenditure is solely due to the increase in the number of patients: slight savings have been made at the level of each individual patient.
What impact would an increase in the fee for medical consultations have on the provision of healthcare?
Cette note effectue l’évaluation de l’augmentation du coût des consultations avec un généraliste inscrit sous Sector 1, qui est entrée en vigueur en 2017.
Reference IPP Policy Brief No. 118
Presentation
Key Results
- As of 1 May 2017, the fee for a consultation with a private general practitioner registered under Sector 1 will rise from 23 to 25 euros.
- Following this 8.7 per cent increase in fees, the practitioners concerned have seen their monthly workload, measured in terms of the number of consultations, rise by an average of 7 to 10 per cent, representing an elasticity of healthcare supply with respect to remuneration of approximately 1.
- This increase stems almost exclusively from a rise in the number of patients (up 11 per cent on average), rather than from a change in the frequency of consultations.
- The rise in patient numbers results as much from an increase in the number of patients seen each day (around +5 per cent, on average) as from an increase in doctors’ working hours (+4 per cent, on average).
- Prescriptions for medicines, relative to the number of patients, fell by 4.5 per cent on average.
- The direct cost of the measure to the National Health Insurance scheme amounted to €500 million in doctors’ fees and €400 million in additional medicine reimbursements. The behavioural response of doctors, in terms of increased activity, should have led to a doubling of these fee-related expenditure, but this was offset by the downward trend in the supply of healthcare over the period.
