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Health, Marine Tondelier

Extra-billing by doctors: Extra fees capped at 50% of the tariff, banned for the lower-income half

Direction of change: decrease, compared with current law.

The lever. Sums charged by some doctors above the social security tariff: regulation, capping, ban. Direction rule: ↑ freer extra-billing.

« Encadrer les dépassements d’honoraires chez les spécialistes en limitant les dépassements d’honoraires à 50 % du tarif de la Sécurité Sociale et en interdisant les dépassements pour la moitié des ménages les moins aisés. »1

Translation by the editorsRegulate excess fees charged by specialists by limiting excess fees to 50% of the social security tariff and prohibiting excess fees for the less well-off half of households.

Encoding

Position linked to an option of the cost schedule, with no parameter to set: see the costing.

Costing

Announced by the candidate

not announced

The programme does not cost this measure.

Published costings

none

No external costing of this position recorded to date.

Our calculation

€0bn

per year for the public accounts, zero cost.

The calculation

  • Ban or cap without public coverage (budgetary cost): Option costed by the source: a cost of €0bn per year.

Partial costing. Only the regulation is costed, at zero cost to public finances. The counterpart provided for in the same proposal (p. 111), « revaloriser le tarif de Sécurité Sociale des spécialités peu valorisées (psychiatrie, pédiatrie, gynécologie, dermatologie) » [“raise the social security tariff for undervalued specialities (psychiatry, paediatrics, gynaecology, dermatology)”], has a cost for national health insurance (Assurance maladie); it is not costed, for lack of an amount.

Current law, sources and limits of the cost schedule

Current law. Sector 2 with unregulated fees « avec tact et mesure » [“with tact and moderation”]. OPTAM moderation scheme. 56% of specialists practise in sector 2. Extra fees reach €4.3bn for specialists and €4.5bn for all doctors in 2024, rising 5% a year in real terms over 2019-2024 (HCAAM, 2 October 2025).

Horizon. full year 2032, €bn/year

Limits. €4.5bn (all doctors, 2024) and +5% per year in real terms over 2019-2024 (+8% in current euros): HCAAM report of October 2025. Central value for 2032: €4.5bn × 1.03^8 (nominal growth of 3%, assumption). High value: €4.5bn × 1.05^8; it applies the real rate of 5% as a nominal rate, and the nominal trend of 8% would give more (calculation: €8.3bn); the range rests on growth assumptions, not on a published costing for 2032. A ban without compensation costs the budget nothing, but may lead doctors to leave the national agreement (déconventionnement) or reduce the supply of care (cannot be costed). Part of the extra fees is already reimbursed by supplementary insurers, and thus not by public spending.

How to read these amounts. These are static costs and revenues, with no feedback effect, over a full year: nothing on growth, employment or the revenue that economic activity would gain or lose. A higher net cost does not on its own make a worse policy, nor net savings a better one: each programme rests on an economic model (demand-led stimulus, lower compulsory levies, consolidation of the public accounts…) that the cost schedule does not settle. GDP itself measures a volume of activity, not well-being or the usefulness of what is produced. Economic models and feedback effects.

This lever in the method · Costing for Marine Tondelier

  1. Pour une prospérité écologique, programme des Écologistes, p. 111. Open the document at this page.

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