“Rabbit tax”: are there really 27 million unfulfilled medical appointments in France each year?

“When you have an appointment with the doctor and you don’t come without warning, you pay,” warned Gabriel Attal during his general policy speech on Tuesday January 30

“Rabbit tax”: are there really 27 million unfulfilled medical appointments in France each year?

“When you have an appointment with the doctor and you don’t come without warning, you pay,” warned Gabriel Attal during his general policy speech on Tuesday January 30. The financial penalty for unkept appointments, or “rabbit tax”, promised by the Prime Minister, aims to “empower” patients while compensating doctors.

This recurring demand from private doctors was brought forward in January 2023 by a joint press release from the National Council of the Order of Physicians and the Academy of Medicine, deploring that “each week 6% to 10% of patients do not show up at their appointment, which corresponds to a loss of consultation time of nearly two hours per week for the doctor regardless of the discipline and, by extrapolation, nearly 27 million appointments not honored per year.

According to these two organizations, the “rabbits” posed to practitioners have “serious repercussions on the provision of care”, disrupt the daily work of doctors and contribute to increasing the number of patients seeking emergency services.

Asked about the origin of these figures, the National Council of the Order of Physicians refers to the association of liberal doctors of the Regional Union of Health Professionals of Ile-de-France (URPS-IDF) which is in the origin.

Indeed, this “France-wide” estimate is put forward for the first time in a press release in July 2022 from the URPS-IDF. It is based on the results of a questionnaire carried out among private doctors in Ile-de-France. Out of 16,000 Ile-de-France doctors, 2,240 responded (including 855 general practitioners). To the question “On average, how many unkept appointments do you see per day? ”, they had a limited and imprecise choice of “zero,” “one to two,” “three to five,” or “more than five.”

95% of respondents report at least one missed appointment per day. As URPS-IDF explains to Le Monde, this figure was multiplied by the number of private doctors in France (100,000 in 2022) and by the number of annual working days (forty-five six-day weeks) to lead to the extrapolation of 27 million annual consultations not honored at the national level.

In detail, 43% of survey respondents estimate that unkept appointments represent 0 to 5% of their work, and 37% between 6% and 10%. However, it is this last figure which was taken up by the National Council of the Order of Physicians and then by the amendment presented to the Senate.

The estimate of 27 million “rabbits” constructed from the URPS-IDF survey is not statistically robust. Other organizations have tried to quantify the phenomenon, in the absence of an exhaustive study among health professionals or a statistical study carried out among a representative sample of French practitioners.

– Surveys exist, with very limited representativeness

The departmental council of the Order of Physicians of the North carried out a survey of only 200 doctors randomly selected in January 2023. On average, “rabbits” represent 7.6% of consultations among the 150 respondents carrying out consultations, all specialties combined, or two hours lost per week. Only 15% of them are reassigned to new patients.

A questionnaire was sent in March 2022 by the URPS private practice Grand-Est to 7,364 doctors. It received only 517 responses, including 303 from general practitioners and a handful from each specialty. The number of missed appointments amounts to an average of 3.83 out of 102 per week in general medicine. The survey also publishes details of the number of weekly “rabbits” and the equivalent in “lost weeks of activity”, specialty by specialty, but with a very small sample of respondents: twenty-six pediatricians, eight ophthalmologists, two gynecologists. …

The union of general practitioners MG France also launched a survey of its members in January 2024. According to the first results, the general secretary of the union, Jean-Christophe Nogrette, estimates that on average 2.5 appointments per week are not honored by each general practitioner, i.e. approximately 6 million missed appointments out of 250 million annually.

– Broader statistical results, but with a limited scope

The Doctolib platform also quantified the “rabbits” posed by users of its application. Based on the 30 million appointments in September and October 2022, Doctolib estimates 3.4% of missed appointments with general practitioners and pediatricians (without cancellation or prior information), 4.5% for others specialists and 6.2% for dentists.

The platform also analyzed the replacement rate for appointments canceled late (less than forty-eight hours before the date) and notes that it amounts to more than 75% for general practitioners and pediatricians, compared to a out of two in other specialties.

These figures present a certain robustness, but are only representative of the practitioners present on Doctolib – only a third of general practitioners practicing privately are present on the platform.