France

Health systems in transition France 97
doctor and 29 quality indicators with intermediate and final targets. Overall,
the amount earned may exceed €7000 per year for a doctor achieving over 85%
of the targets and treating more than 1200 patients. There is no penalty for
the GPs who do not achieve the targets. In 2012, more than 89 000 physicians
participated in the programme, receiving an average annual remuneration of
€4215.
Physicians employed in public hospitals
Doctors working in public hospitals are state employees who benefit from
conditions of employment similar to civil servants. The method and amount of
payment vary according to category:
• university hospital doctors are categorized as state employees because of
their teaching responsibilities; their pay is composed of a university salary
for their teaching responsibilities and hospital fees that correspond to their
treatment responsibilities; levels of pay correspond to grades on a national
seniority scale;
• full- or part-time hospital doctors with tenure or on contract are paid on a
monthly basis according to their grade (seniority) and the time worked; they
also receive various allowances for being on call; and
• external practitioners working in hospitals on an intermittent basis (attachés)
are paid on a monthly basis in proportion to the number of sessions they
undertake, with allowances for being on call.
University hospital doctors are authorized to devote a part of their
working time to private practice within the hospital. Their fees are received
by the hospital administration, which transfers them to the practitioner after
withholding their own fees for use of facilities.
Pharmacists
Since January 2000, pharmacists have been paid based on a mixed system
linking a fixed-sum component (€0.53 per item) and a digressive sliding-scale
margin; however, remuneration of pharmacists is evolving towards a fee-based
system (honoraire de dispensation). Starting in January 2015, pharmacists will
be paid a fixed sum of €0.80 per drug package (increasing to €1 in 2016), in
exchange for a reduction in the price-based margins. Since 2013, pharmacists
are paid for consultations with asthmatic patients and those treated with
anticoagulants (€40/patient).