Le secteur optionnel : effet d’aubaine ou outil de régulation des dépassements ?

In France, physicians, who are paid under a fee-for-service scheme, belong to two “sectors”: in sector 1, overbilling is forbidden whereas it is allowed in sector 2. Given the huge increase in overbilling over the past few years, the French government decided in March 2012 to create a new sector (named “secteur optionnel”) that restricts the amount of overbilling allowed, and that physicians can voluntarily join. Using two exhaustive datasets on all physicians practicing in France in 2008 (one drawn from fiscal records, the other by the public health insurance), the aim of the paper is to examine the attractiveness of this new sector, its potential impact on the global amount of overbilling and its cost for the public health insurance. We find that 40% of physicians would benefit financially from joining this new sector but the impact on overbilling appears to be rather limited: depending on the assumptions, it would lead to a 7% drop or to a small increase. Beyond the legal definition of the “secteur optionnel”, we study the impact of several other possible mechanisms aimed at controlling overbilling: making the “secteur optionnel” compulsory for all physicians, or only for those who settle in an area where medical density is already very high. Our simulations cast a new light on the debate on excess medical fees and their regulation, in a context in which the offer under reference fees is running rare.