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HEALTH

France to fine patients who miss medical appointments

France is to introduce a five euro penalty for people who fail to turn up for millions of doctors' appointments missed each year, the prime minister said Saturday.

Published: 7 April 2024 11:47 CEST
A doctor calls a patient in the waiting room at the surgery consultation at Argenteuil hospital, north of Paris
A doctor calls a patient in the waiting room at the surgery consultation at Argenteuil hospital, north of Paris on July 19, 2013. The French government plans to fine patients who don’t attend appointments. (Photo by Fred DUFOUR / AFP)

The fine was one of several measures announced by Prime Minister Gabriel Attal to boost a health service struggling to keep up with increasing demands from an ageing and growing population.

“We cannot allow this,” Attal said of the 27 million consultations that the main doctors’ union says are wasted each year by patients not turning up.

Attal said the measure could free up between 15 million and 20 million appointments for other patients.

He said a law allowing a “mechanism for responsibility” would be put to parliament and that the government wanted the penalty to start from January 1.

The money would be paid by any person failing to turn up for an appointment or who gives less than 24 hours notice.

Individual doctors will decide if the reason for missing an appointment was good enough to avoid the financial penalty.

The prime minister will also seek to increase the number of students finishing high-pressure medical training in a bid to answer a critical shortage of doctors.

He said the number of students entering the second year of medical degrees would rise from 10,000 a year in 2023 to 12,000 in 2025 and 16,000 in 2027.

Medicine is considered one of the toughest university degrees in France with up to a third of students dropping out at the end of the first year.

Officials acknowledged that the change may only affect the French health service from 2035 because of the time it takes to train doctors.

Attal told a press briefing that there would also be an experiment from next year to allow patients to make appointments with some specialists without being referred by a general doctor — which is the current rule.

The proposal was criticised by the main union for general practitioners, MG France, which insisted “it will not solve anything” as there is the same shortage of specialists as for generalists.

Attal’s advisors said action was critical as getting reliable access to a doctor was one of the main gripes of French voters.

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POLITICS

What does the new government mean for foreigners in France?

France at last has a new government and one of its four main aims is to "control immigration and promote integration" - so what is this likely to mean for foreigners in France, or those hoping to move here some day?

Published: 20 September 2024 10:36 CEST
What does the new government mean for foreigners in France?

After two weeks of intense negotiation, on Thursday evening newly-appointed prime minister Michel Barnier announced that he had succeeded in forming a government.

 He also laid out his four main priorities;

  • Improve the standard of living for the French and the workings of public services, especially schools and healthcare
  • Guarantee security, control immigration and improve integration
  • Encourage businesses and agriculture and build upon the economic attractiveness of France
  • Get public finances under control and reduce debt

He is set to give his Discours de politique générale on October 1st – this is the traditional speech that a prime minister makes laying out the main policy aims of their government.

So what is this likely to mean for foreigners living in France?

Obviously some of these things will have the same effect on foreigners as any other residents of France, since we all use the same healthcare and education systems.

The first challenge for the new government will be a budget that, as Barnier says, “gets public finances under control”. France is facing a ballooning deficit and the threat of a downgrade from ratings agencies if it cannot get spending under control.

Barnier said earlier in the week that he is “discovering that the country’s budgetary situation is very serious” – most people interpreted this as preparing to announce tax hikes.

No details of these plans have been released, but it is thought likely that extra taxes will be on business and the super-rich rather than any increase in income tax or VAT.

Emmanuel Macron’s centrist Renaissance group briefed the press that one of their conditions for joining the new government was a pledge that any tax increases would not target “the middle classes or working French people”.

Immigration

But the strand of government that is most likely to affect foreigners in France, or those hoping to move here some day, is the pledge to “control immigration and promote integration”.

Again there is no detail on this, but the French government’s most recent bill to “promote integration” introduced language tests for certain types of residency card, while raising the language standard required for other processes.

We know that Barnier himself is strongly to the right on the topic of immigration – in his unsuccessful 2022 bid for the Les Républicains presidential nomination he called for a total moratorium on all immigration into France from non-EU countries.

Barnier said he would organise a referendum if elected, asking voters to approve constitutional changes and the ability of parliament to set immigrant quotas each year.

The exact composition of the new government has not been revealed – it is expected “before Sunday” – but we do know that Barnier has appointed several ministers from within the Les Républicains party.

These are reported to include Bruno Retailleau, who sparked outcry with his comments about immigrants in the context of the 2022 riots.

Speaking about the rioters who were arrested, 90 percent of whom were French citizens, he said: “OK, they’re French, but these are French people in their official identity, and unfortunately for the second and third generations (of immigrants), there is a sort of regression towards their ethnic roots.”

Clearly for some politicians, you can never be integrated enough.

New laws?

Although it’s far too early to think of any specific policies – and the government may not last long enough to actually see any laws passed – the debate around France’s recent immigration bill does provide some clues about the goals of right-wing politicians.

The Immigration law that finally passed in January changed – among other things – conditions for certain types of residency card and introduced expanded language tests, a civics test and a declaration of allegiance to ‘French values’ for foreigners living here.

READ ALSO What changes under France’s new immigration bill

However as the bill progressed through parliament, many right-wing lawmakers attempted to add amendments to toughen it up. In the end, most of the amendments were either voted down in parliament or struck out later by the Constitutional Council, but they do provide a guide to right-wing goals.

Among the rejected amendments were;

Migration quotas – the original bill contained nothing about migration quotas, but a section on this was added in the Senate (which is controlled by Les Républicains). The amendment was vague, setting out only the principle that parliament can set migration quotas – the wording of the text talked about ‘economic migration’, suggesting that these quotas would apply only to people coming to France to work, not students or retirees. The quotas would not affect asylum seekers or people arriving on a family reunification visa.

It called for parliament to have an annual debate on migration, with the ‘objective’ of setting quotas or numbers.

This was one of many amendments that was eventually struck out by the Constitutional Council – although on procedural grounds, not because of its content.

Healthcare restrictions – currently undocumented foreigners who are in France for more than three months are entitled to basic healthcare under the Aide medicale de l’Etat, with costs reimbursed by the State for hospital treatment and medication. The amendment proposed a complete ban on this for anyone who is undocumented or in an irregular immigration situation.

Benefit restrictions – currently foreigners in France can qualify for benefits such as housing allowance or certain family benefits after they have been resident for six months, the amendment aimed to increase the qualification period to five years.

Expelling radicalised foreigners – the law that was eventually passed makes it easier to expel radicalised foreigners by removing certain protections, including the restriction that people who came to France aged 13 or under cannot be expelled once they reach adulthood. The amendment aimed toughen this up still further by allowing the expulsion not just of people who are on terror watchlists, but of people who have “committed a grave and deliberate violation of the principles of the French Republic”.

Toughen asylum rules – various amendments aimed to make it easier to expel failed asylum seekers by reducing the amount of time for appeals and allowing a notice to quit the country to be served as soon as a first application is rejected.

Limit family reunification rights – rules around foreigners in France being joined by spouses or family members would also be tightened up under the amendment, with a minimum stay of 24 months before you can be joined by a spouse or family member, and extra financial requirements.

French citizenship for children born in France – currently children who are born in France to foreign parents are automatically given the right to French citizenship once they reach 18 under the droit du sol principle (although in order to do anything practical like get a passport or ID card they still need to apply for a naturalisation certificate). Several amendments proposed that this no longer be an automatic right and children must “express their will” to get citizenship – presumably through an extra admin procedures.

All the immigration measures listed above would apply to non-EU nationals – anyone who needs a visa or carte de séjour to spend more than three months in France.

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