When you made an appointment with your ophthalmologist or dermatologist, did you discover that you had to add 50, 80, or even 100 euros from your pocket? A situation that has unfortunately (become) commonplace for many French people. And according to the latest report from the High Council for the Future of Health Insurance (HCAAM), this could get even worse. To the point of threatening one of the founding principles of the French health system: access to care for everyone, regardless of income.
More and more frequent overruns
Today, consulting certain specialists without paying extra is sometimes a headache. In several territories, doctors charging agreed rates are rare. Result: patients often have no choice but to accept an excess of fees or postpone their appointment.
This situation is directly linked to the progression of sector 2: in this case, doctors can set prices higher than those reimbursed by Health Insurance. And while some health insurance plans cover part of the bill, this is not always the case. Conclusion: the remaining cost can quickly become substantial…
Unfortunately, the High Council for the Future of Health Insurance (HCAAM) believes that this trend is unlikely to improve. In 2026, fee overruns already represent nearly 5 billion euros per year, and without reform, they could exceed “10 billion euros by 2040“.
An increasingly marked risk of inequality
Behind these figures and projections, it is above all the direct consequences which are worrying. When consulting a specialist becomes more and more expensive, some people can no longer absorb the expense and forego care, postpone an intervention or limit their consultations.
In fact, socio-economic and territorial inequalities risk strengthening. While the provision of care without excess is already insufficient in certain regions, the situation could become even more tense in the coming years.
According to HCAAM projections, nearly nine out of ten liberal specialists could even choose sector 2 by 2040. In other words, consultations at Social Security rates could become increasingly difficult to find.
What solutions should you consider?
Faced with this observation, the High Council does not simply take stock of the situation: it proposes several concrete avenues for regaining control over fee overruns.
Among the scenarios studied are:
- Maximum regulation of sector 2, which could tend towards the elimination of fee overruns. “The reform should, however, be progressive: closure of sector 2 to new installations, gradual capping of excesses and price increases”;
- Reinforced supervision of sector 2 in order to preserve access to Social Security rates. “This scenario is based on more restrictive conditions of access to sector 2, such as restricting access to sector 2 to former assistant clinical heads only and making exercise in sector 2 conditional on a number of years of experience”;
- Reinforced control of fee overruns.
Here, the idea would be to establish “rules common to all new doctors (access to excess after a minimum period of experience; excess ceiling applicable to each procedure; revaluation of the least remunerative specialties in order to reduce income gaps)”.
The objective is the same in all cases: to guarantee patients a sufficient supply of financially accessible care. It remains to be seen which solutions will now be adopted.
A subject that could soon find its way into the presidential debate
For a long time, the distinction between sector 1, 2 or 3 doctors remained vague for the general public. But with the increase in fee overruns, this question is now becoming a real political and social issue.
Less than a year before the 2027 presidential election, France Assos Santé calls on all candidates to make a clear decision on the future of fee overruns, considering that “The HCAAM report shows that this is no longer a technical subject but a major issue of social justice, access to care and national cohesion..
Because behind this debate there is a very concrete question: tomorrow, will we still be able to consult a specialist without first looking at our bank account?