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What is the “rabbit tax” intended to stop the surge in missed medical appointments?

“I operated from 5 a.

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What is the “rabbit tax” intended to stop the surge in missed medical appointments?

“I operated from 5 a.m. to 7 a.m. I started my consultations at 8:30 a.m. I saw one. Then two rabbits in a row. I’ve been waiting like an idiot for 40 minutes,” laments this surgeon. “First 2 patients did not come. The 3rd was there. The 4th does not come, but in her place comes a friend of hers, unknown, to take her place, without calling, without asking. Like he was coming to the restaurant. What a day…. It’s starting to bother me,” says a young doctor in despair. On social networks, many people testify, between exasperation and incomprehension, to the multiplication of “rabbits”, these unfulfilled appointments which are on the rise sharply. So many lost slots that could have been allocated to other patients. A scourge, because if the hospital and emergency rooms are embolized, it is also because the French are unable to make appointments in town.

To make patients who do not keep their appointments responsible, LR senators introduced a “rabbit tax” into the Social Security financing bill currently under consideration. Concretely, when an appointment with a local healthcare professional has not been honored by the insured, a lump sum will be charged to the latter. Its amount would be fixed by decree and allocated to Health Insurance. The amount can be paid directly by the insured person to their fund, taken from their bank account with their authorization or recovered, by the Health Insurance organization, from future benefits of any kind. “Faced with problems of access to care, when there is a shortage of doctors, it is a way of reminding us that medical time is precious,” explains Corinne Imbert.

Already, last February, when the Rist law was being examined, senators had voted for an amendment establishing “compensation for the doctor at the expense of the socially insured person” who would not honor his appointment. In Germany, for example, patients pay 5 euros when making an appointment, the amount remaining with the professional in the event of no-show. But this time, the government seems convinced. “We must re-empower our fellow citizens. It’s on average one appointment per day per healthcare professional,” says Agnès Firmin Le Bodo. “Perhaps we will have to think about a system that goes further.” Already last April, Emmanuel Macron in an interview with Le Parisien also affirmed that we needed to “give patients greater responsibility”, announcing that “those who do not come to appointments, we are going to sanction them a little”.

The lack of civility of certain patients, who do not even take the trouble to notify when they cancel an appointment, has irritated doctors for months. The profession had alerted the attention of public authorities to this growing scourge. More than 40% of general practitioners report at least five unkept appointments per week, according to a survey published Monday by our colleagues at “Generalist”. The National Academy of Medicine and the National Council of the Order of Physicians estimated, at the start of 2023, that the phenomenon affected 6 to 10% of patients with an appointment each week. Nearly two thirds of these defections concern a first meeting. “Already in 2015, we conducted a survey of 2,800 doctors, which showed that on average doctors lost 40 minutes per day because of these “rabbits”. 71% of doctors noted at least one or two appointments per day that were not kept,” recalls Dr. Valérie Briole, president of URPS Île-de-France.

For its part, the National Health Insurance Fund (Cnam) cites an appointment cancellation rate which could be between 3 and 4%. It focuses more on pedagogy than on punishment. To this end, on October 8 it launched a national information campaign, with little rabbits waiting on chairs in the waiting room, in order to raise awareness about the proper use of the health system and the action to be taken in the event of cancellation of appointments. “We have just launched a campaign to make patients responsible and remind them of basic citizenship which consists of warning them if they cancel an appointment in order to limit the “rabbits,” Thomas Fatôme, director of Insurance, told Le Figaro. -disease. We will continue this pedagogy.” The subject will also be on the agenda of the negotiations which reopened on Wednesday on the price of consultation and access to care between doctors' unions and Health Insurance.

Denouncing a "scapegoat of users", France Assos Santé, representing patient associations, recalls that according to the public health code "the doctor's fees (...) can only be claimed from the opportunity for acts actually carried out” and calls for prioritizing user information campaigns as well as the accountability of platforms. Because the phenomenon has accelerated with the rise of online appointment booking. Leader in the sector, Doctolib already sends SMS reminders to patients and prevents them from making appointments over the same period with several doctors in the same specialty. Despite this, the problem remains.

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