taxis and patients worried about cuts to health transport

IN 2023, Dora continues radiotherapy sessions at the Gustave-Roussy center, in Villejuif, very close to Paris. To follow his cancer treatment, his doctor wrote him a transport prescription which gives him access to health taxis reimbursed by Social Security. The 52-year-old executive, who intends to continue working, has scheduled all her medical appointments during her lunch hours. “I still had to make my own way to get to my sessions because I couldn’t find taxis,” she recalls.

In ten years, health transport expenses reimbursed by Social Security have increased regularly but especially jumped between 2022 and 2023, to reach 6.3 billion euros. A sum to be compared to the 13.8 million patients suffering from a long-term condition* (ALD) in 2024, or 20% of the French population, thus causing demands for mobility in the healthcare sector to explode. Such increased costs are becoming less and less sustainable as public debt reaches record highs.

Contracted taxis, which provide around a third of this type of travel, are the first to cost health insurance dearly. The last agreement that it negotiated with taxis in 2024, less advantageous for them, must be validated in the next Social Security financing bill, currently on hold. For several months, drivers have been mobilizing to put pressure on each other.

Need for profitability

Corporatist reflex? Approved taxis are not like other taxis: they operate on medical prescription and meet crucial needs, in particular for the elderly and those with reduced mobility.

Of course, there are excesses – overbilling, inflated mileage – but at the margins. If their business model is no longer profitable, some will give up the steering wheel. However, fewer taxis available mean fewer opportunities for patients to get to appointments. Patients also risk ultimately suffering the effects of the budgetary tightening. This is particularly true in rural areas.

Fernande, 88 years old, lives in La Capelle-Bleys, an Aveyron village of 344 inhabitants. Treated in Rodez, the octogenarian must travel nearly 120 km round trip for each appointment. “Before, my husband drove me. Now that I am a widow, I have no choice but to take a taxi,” she explains. In the countryside, in fact, the vast majority of drivers are approved. And very much in demand.

After feeling unwell while driving, Dominique Lelys had to use this service for her dialysis sessions in Nogent-le-Rotrou, in Orne. “I quickly found companies around me, but it is sometimes complicated to be able to set regular appointments,” he notes. According to the unions, if the new pricing is applied, 30,000 jobs could disappear. “Certain communities of municipalities have not taken the necessary means to allow access to care,” storms Dr Luc Duquesnel, president of the Confederation of French Medical Unions (CSMF). Some experts also warn of a possible “cascade” effect: as Social Security seeks to reimburse less, supplementary health insurance will take over and could pass the additional cost onto patients.

Shared vehicles

In response to these pitfalls, a draft decree, awaiting signature, should make shared medical transport compulsory, already in place in several departments. In Dordogne, Sandra Laure Naboulet, manager of Taxi Segonzac, makes 30% of her journeys in this mode. The passengers, often retired, enjoy meeting other patients. But in the city, where traffic jams are common, the idea is not as well received. Neither by users nor by taxis.

However, health insurance has set criteria to streamline the service – maximum detour of 10 km per passenger, waiting time of forty-five minutes at most. But Christophe Van Lierde, president of SATC 92, does not budge: “When it already takes thirty minutes to travel four kilometers in Paris, these measures are inapplicable. Patients are already stressed by their illness, why worry them more by having to make detours that risk causing them to miss their appointment? » Patients always have the option of refusing – and then paying up front – or traveling on their own and then being compensated by health insurance. But you still need to have a car or a loved one to act as driver. And in both cases, be patient while waiting to be reimbursed.