French general practitioners who earn less than some of their European counterparts: this parallel masks very heterogeneous conditions of exercise.
by minh dréan and Eve chancel
Double the price of the consultation. It was the main claim of the Doctors collective for tomorrow, which recalls that the price of a consultation in France – 25 euros – is well below the average in the Organization of Economic Cooperation and Development (OECD) – 46 euros. In Belgium too, some doctors had campaigned in this direction. In mid-December 2022, the Belgian Medical Union Association announced that the consultation price would be upgraded from 27 to 30 euros from 1 er January 2023. Nevertheless, compare the prices of consultations in Europe “does not really make sense as the systems are different,” warns the health economist Philippe Batifoulier.
In France, the general practitioners are paid 80 %, that is to say that they affect remuneration for each consultation. The rest comes from packages depending on the type of patient or productivity indicators. In Germany, payment on the act also exists, but takes a different form: “health insurance manages this payment to the act within the framework of a global envelope, explains Philippe Batifoulier. Every year, there has a budget for general medicine which is decided -the latter remains the same, regardless of the number of acts performed -, it is then distributed to medical unions which distribute it. “
In the United Kingdom, the system operates by capitation: doctors are paid compared to the size of their patients. The practitioner perceives a lump sum per patient registered with his cabinet, regardless of the volume of care provided.
“The price of the consultation, insufficient indicator”
The price of the consultation is therefore not a sufficient indicator “since it is only part of the real remuneration of doctors”, recalls Gaétan Lafortune, economist at the OECD Health Division . In a report dating from 2020, the OECD showed that French general practitioners have lower income than their counterparts in Austria, Germany, Switzerland and United Kingdom, income almost equal to those of their Irish colleagues and higher than in Belgium and the Netherlands. “Differences in wages which correspond above all to different conditions of exercise, which complicates the comparison”, supports the economist of the OECD.
In France, doctors are free to choose the place where they exercise. In the United Kingdom, their installation is regulated by the State according to needs. The system is even more restrictive in Spain, where they must meet several implantation criteria, some relating to the journeys of the most remote patients for example. In Germany, new practitioners can only settle in areas where the number per capita is lower than a threshold fixed at the national level.
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