The Ban on Extra-Fees for Beneficiaries of the CMU-C Health Cover: What Consequences for Physicians and Dentists in Private Practice?

[eng] Whilst it is forbidden to charge patients with CMU-C health cover fees in excess of the reimbursable regulated fee (or extra fees), so as to make their access to care easier, field experiment studies report discrimination against the latter by physicians. This issue is approached here from the angle of healthcare supply, using four waves of longitudinal administrative data on physicians in private practice between 2005 and 2014. We examine whether this ban on excess fees for CMU-C beneficiaries, i.e. charging them fees in excess of the standard social security-negotiated fees agreed under the public health insurance scheme, generates a real financial constraint for Sector 2 physicians (those who charge extra-fees) and dentists in private practice. Estimates show a significant drop in the average extra-fees per procedure when physicians accept more CMU-C patients in their practice. Even if costs are transferred (cost-shifting), with other patients being charged higher extra-fees, this is not enough to offset the financial impact. However, this restriction does not have a negative impact on total fees for Sector 2 specialists, general practitioners and dentists, as they increase their volume of activity at the same time.