Double the price of the consultation. This was the main demand of the Doctors for Tomorrow collective, which reminds us that the price of a consultation in France – 25 euros – is well below the average in the Organization for Economic Co-operation and Development (OECD) – 46 euros. In Belgium too, some doctors had campaigned in this direction. In mid-December 2022, the Belgian Association of Medical Unions announced that the price of the consultation would be increased from 27 to 30 euros from 1is January 2023. Nevertheless, comparing consultation rates in Europe “doesn’t really make sense as the systems are so different”warns health economist Philippe Batifoulier.
In France, GPs are paid 80% on a fee-for-service basis, ie they receive payment for each consultation. The rest comes from flat rates depending on the type of patient or productivity indicators. In Germany, fee-for-service also exists, but takes a different form: “Medicare manages this fee-for-service payment as part of a global envelopeexplains Philippe Batifoulier. Every year, there is a budget for general medicine which is decided – the latter remains the same, regardless of the number of acts carried out –, it is then distributed to the medical unions which distribute it among themselves. »
In the United Kingdom, the system works by capitation: doctors are paid according to the size of their patient population. The practitioner receives a lump sum per patient registered with his practice, regardless of the volume of care provided.
“The price of the consultation, an insufficient indicator”
The price of the consultation is therefore not a sufficient indicator “since it is only a part of the actual remuneration of doctors”, recalls Gaétan Lafortune, economist in the health division of the OECD. In a report dating from 2020, the OECD showed that French GPs have lower incomes than their counterparts in Austria, Germany, Switzerland and the United Kingdom, incomes roughly equal to those of their Irish colleagues and higher than in Belgium and the Netherlands. “Differences in wages which correspond above all to different working conditions, which complicates the comparison”supports the OECD economist.
In France, doctors are free to choose the place where they practice. In the United Kingdom, their installation is regulated by the State according to the needs. The system is even more restrictive in Spain, where they must meet several criteria for setting up, some relating to travel times for the most remote patients, for example. In Germany, new practitioners can only set up in areas where the number per capita is below a nationally set threshold.
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