French patients will have to pay a fine of €5 if they miss a doctor’s appointment after about 27 million no-shows a year incurred heavy losses.
Gabriel Attal, the prime minister, announced the penalty along with other measures to support the health service as it struggles to cope with increasing demands from an ageing population.
The plan immediately came under fire from doctors’ unions and patients’ groups.
“This won’t work,” Patrick Pelloux, head of the emergency doctors’ union, told RMC radio. “It’s just a tax and the health service could suffer.”
Gérard Raymond, president of Assos Santé, a patients’ group, said: “This isn’t a way of making patients more responsible but an attempt to blame them and make them feel guilty for the system’s shortcomings.”
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Attal said that the health service could no longer afford the time wasted when patients failed to turn up. Penalising them could free up to 20 million appointments a year for other patients, he claimed. “We can’t allow this to continue,” he said.
Under the plans, patients would be obliged to give debit or credit card details when arranging an appointment. If they fail to turn up without giving at least 24 hours’ notice, doctors would be allowed to fine them but could exempt patients with a valid reason for missing their appointment.
Responding to mounting public criticism over a shortage of doctors, especially in rural areas and small towns, Attal also said more doctors would be trained.
Some parts of France have been labelled “medical deserts” because they lack doctors and medical facilities, forcing residents to travel great distances for care. The government said its aim was to ensure that everyone had a doctor within 30 minutes of their home.
Attal said that the number of second-year places in medical schools would increase from 10,000 to 12,000 next year, and to 16,000 in 2027. A third of students drop out after the first year of medicine.
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Doctors’ unions, however, argue that the best way to increase the number of general practitioners is to improve their pay and conditions. “You have to recognise the value of GPs and make it more rewarding,” said Richard Handschuh, a doctor in Paris and member of MG France, a GPs’ union.
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A GP in France earns an average of about €85,000 a year, according to health service statistics. Those in the state health service are paid by consultation — €26.50 per appointment — but unions are demanding an increase to €30 or even €50. Pay negotiations are deadlocked.
The government wants to expand the roles of medical assistants, nurses and midwives to ease pressure on doctors. It is also planning to allow patients to see specialists without being referred by a GP to reduce the backlog of appointments.
MG France said: “This will not solve anything because there is a shortage of specialists as well as GPs.”
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The announcements may affect the European elections in June, in which the public perception of a declining health service is helping the populist right and hindering President Macron’s centrist party. Marine Le Pen’s National Rally is on course to win more seats than any other French party, which could bolster her chances of victory in the next presidential election in 2027.
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The government wants the fines to start from January 1 and Attal said new legislation would be brought before parliament. An earlier bill to introduce a penalty was passed last year by the Senate, the upper house, but then rejected by the National Assembly, the lower house.
The French health service offers universal medical care largely funded by national insurance contributions. It is topped up by relatively inexpensive private insurance, often provided by non-profit “mutuelles”.
Unlike the British system, which is free at the point of delivery, many patients in France have to pay a percentage of their medical costs. The state generally refunds at least 70 per cent, and 100 per cent for expensive treatment or chronic conditions.
