No question of burying him. This Wednesday, the “rabbit tax” made its comeback in the Prime Minister’s general policy speech. “We are going to charge those who do not show up for medical appointments without warning,” promised Gabriel Attal. For the head of government, the time has come to sanction these ghost patients who cause health professionals to lose nearly 2.5 million consultations per year. It remains to be seen when and how. Contrary to what Gabriel Attal suggested, the task could turn out to be less “simple” than it seems. What might the future “rabbit tax” look like? How could it work and how much would it cost? Le Figaro looked into the question.
If we still do not know how the government intends to go about stemming the scourge of "medical rabbits", we already know what it does not want: in November, the government closed the door to a tax mechanism proposed by senators as part of PLFSS 2024. The project was based on a financial sanction directly recovered by Health Insurance. The sum, the amount of which remained to be defined, was to be withdrawn from the insured's bank account or withheld from future reimbursements. Part of this amount, if not all of it, fell to the injured practitioner. Not convincing enough in the eyes of the executive, which ended up censoring the project by resorting to 49.3. The Minister of Health Aurélien Rousseau explained that he had “not found the solution” which would allow patients to be treated fairly according to their method of making appointments. A few months earlier, the executive had already rejected the idea of a punitive tax brought by senators as part of the Rist law.
In April 2023, Gabriel Attal, then Minister of Public Accounts, pleaded for a financial penalty. “If you do not show up, the reimbursement for the next appointment would be reduced by a certain amount.” Amount that would be shared equitably by the Primary Health Insurance Fund (Cnam) and the practitioner. A few months later, his successor at Bercy, Thomas Cazenave, was more evasive. Favorable for “a mechanism that allows us to punish” ghost patients, he seemed hesitant about the nature of the punishment. “I don’t know if it will be a tax,” he said.
The government has not been more forthcoming about the role that Doctolib-type platforms could play. Will they be responsible for taking a bank imprint each time an appointment is made, as some platforms dedicated to teleconsultation already do? “For the moment, no working meeting is planned with the ministry,” whispers a spokesperson for the sector.
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Far from the procrastination of the executive, doctors are full of imagination. “There are several solutions: either a Doctolib type platform provides a deduction, which we would like to pay back to doctors, or Health Insurance collects the sanction and allocates it to the fund,” explains the president of the Union of Liberal Doctors (SML) Sophie Bauer. Health insurance or doctors, therefore. Like Gabriel Attal, the president of the French Union for Free Medicine (UFML) Jérome Marty leans towards an intermediate solution. “Part of the sanction must necessarily go to the doctors. When we are in an area where rabbits reach up to 30 missed consultations per month, it is untenable.
But, before trying to sell it again, we still need to define the size of the cake. How much will the punishment for ghost patients be? Health professionals hope for compensation commensurate with the damage suffered. “The sanction could go up to the total amount of the consultation not honored,” estimates Sophie Bauer. “Personally it wouldn't shock me if we went up to 25 euros for a missed consultation with a general practitioner. But we have to study it,” adds Jérôme Marty.
The white coats will undoubtedly have to lower their ambitions. In January 2023, in the columns of Le Parisien, the President assured that incivility in terms of medical appointments would be “a little sanctioned”, nothing more. During his visit to Bercy, Gabriel Attal leaned in favor of a moderate punishment: ten euros, “five for the health professional and five for Health Insurance”. The executive could be tempted to stay this course, in line with the “rabbit taxes” of our German (five euros) and Belgian (fifteen euros) neighbors.
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It remains to remove the legal obstacle. Article R. 4127-53 of the Public Health Code stipulates that “doctor’s fees […] can only be claimed for acts actually carried out”. The same obligation is included in the medical code of ethics. Opponents of the tax (MG France, France Assos Santé, etc.) did not fail to put forward this argument to disqualify the government's project. We will therefore have to agree to modify the public health code, that is to say the law, in order to hope to overcome ghost patients.
But the difficulties will not end there. “How will the doctor be able to prove to Health Insurance that a patient did not show up, if the latter claims the opposite?” asks Jérome Marty. “Many lawyers have assured me that it will not be as simple as that.” In fact, sorting out fact from fiction could prove Kafkaesque. Health Insurance, which already tracks fraudulent acts and abusive sick leave, could thus be assigned a new control mission: that of verifying the good faith of doctors (and patients) in the context of a possible “tax rabbit". Not sure that this prospect delights the Security agents...