The president of the High Council for the Future of Health Insurance (HCAAM), Yann-Gaël Amghar, is warning of a sharp increase in fee overruns: if no reforms are implemented, 90% of specialists could be practicing in the private sector (sector 2) by 2040, compared to just over half today. The total amount of these overruns would reach more than €10 billion, more than double the 2025 figure. This trend would increase out-of-pocket expenses, already very high for certain procedures, such as a hip replacement, which can cost low-income patients around €800.
Patient associations, such as France Assos Santé, denounce a "two-tiered" healthcare system that penalizes those most in need of care.
To address this trend, the HCAAM proposes several solutions:
- Prohibit overruns for patients with the lowest incomes.
-Limit access to Sector 2 by making it conditional on seniority.
-Set caps on overbilling, for example, 1.5 to 2 times the Social Security rate, in order to gradually phase it out.
According to the report, if all Sector 2 specialists were to revert to Sector 1 conditions, 95% would see their income decrease by approximately 28%, which would necessitate an increase in fees for certain specialties such as psychiatry, pediatrics, and gynecology.
For its part, the Confederation of French Medical Unions disputes the idea that overbilling limits access to care. It explains the increase by the need for additional training to access Sector 2 and by the low remuneration for many technical procedures, a symptom of a system that undervalues certain practices.
 Pascal Lemontel
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10/06/2026 | 
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