€5 penalty proposed for missing a medical rendez-vous in France

A €5 fine for missing a medical appointment has been officially proposed by prime minister Gabriel Attal, alongside a number of other updates intended to reduce pressure on France’s healthcare sector.

The so-called taxe lapin (rabbit tax) would free up between 15 and 20 million appointment slots per year, reducing pressure on GPs and specialists, as well as make people more responsible when booking appointments, the government said.

It believes that the charge will encourage people to cancel in advance – or only book an appointment if they really feel they need it – allowing appointment slots that were formerly wasted by people not turning up to be rescheduled and used effectively.

It is known as a rabbit tax due to the French phrase poser un lapin, which means to stand someone up / not turn up to an appointment.

Read more: Petit lapin, coup du lapin: 6 commonly used French rabbit expressions

The Union régionale des professionnels de santé d'Île-de-France says that 27 million booked appointments per year see patients either not show up (having not cancelled in advance). 

Healthcare and appointment booking platform Doctolib says around 4.1% of appointments made through the service result in ‘no shows’.

Some unions have voiced opposition to the charge, however, claiming the issues are related to the ‘chaos’ of the healthcare system and the lack of GPs. 

“When you make an anonymous appointment with a doctor you don't know, you're more likely not to keep it. When you go to a doctor you know, with whom you are being treated, it's extremely rare not to turn up,” said Richard Handschuh, a GP and member of the MG France union, to BFMTV.

The change is scheduled to come into force on January 1, 2025, but has yet to be officially voted on in parliament.

How would the €5 charge work?

The charge would be levied on people who either do not show for appointments or who cancel with less than 24 hours’ notice.

The prime minister said healthcare specialists could themselves choose not to levy it on an individual basis depending on the patient’s reasons for not turning up.

A system such as in Germany – which has a similar rule – may be implemented to collect the fine with patients paying a €5 deposit. This is then refunded when they turn up (or deducted from other costs of the appointment). 

Alternatively, platforms such as Doctolib (or specialists if contacted directly) may ask patients to authorise a pre-payment (empreinte bancaire) for the appointment.

This pending payment would be cancelled if the patient shows up or authorised so the money taken out of their account if they do not. 

 Read more: How do hospital fees work in France?

What other changes were announced? 

Other changes proposed by the prime minister include direct access to certain specialists such as physiotherapists, cardiologists, etc without first needing to go through a GP. 

In theory, this would reduce appointment strain for GPs, but there are doubts it would impact the already long queues to see a specialist.

Read more: Wait to see health specialists grows in France: here is what to expect

There will also be additional spaces for medical students from 2025 onwards, and additional support for mental health appointments through the Mon Soutien Psy scheme.

Medical students in France are accepted through a concours-style examination, meaning only a set number (for example the top 10%, or top 50 highest-scoring) are accepted, as opposed to all receiving above a certain grade.

Finally, an expansion of what prescriptions pharmacists can dispense, including for sore throats and cystitis, may come into force as early as June 2024.

Read more: French pharmacies now able to prescribe antibiotics…but GPs sceptical

Many of these ideas have already been raised by the prime minister, either during his time as Minister of Public Action and Accounts, or his policy speech after becoming prime minister at the beginning of 2024.