After a week of growing unrest on the streets of France, particularly in Paris, taxi drivers are stepping up their resistance to a proposed overhaul of the medical transport reimbursement system. The dispute, which has seen thousands of drivers block roads, protest outside government buildings, and create widespread disruption at transportation hubs, now moves into a more formal phase. This Saturday, representatives of the taxi unions are set to meet with officials from the Ministry of Transport, joined by none other than Prime Minister François Bayrou, for high-level talks aimed at breaking the impasse.
A Nation on Hold Over a Health Reform
At the core of the standoff is a controversial new convention proposed by the national health insurance system (Caisse nationale de l’Assurance maladie, or CNAM). The reform seeks to standardize patient transport fares across the country—replacing the current patchwork of regional pricing models with a unified structure. It introduces a fixed base reimbursement of €13 per journey by CNAM, followed by a per-kilometer rate. While the government argues this is a rational step toward controlling ballooning healthcare transport expenses, many taxi drivers claim it will gut their livelihoods.
The policy is scheduled to go into effect on October 1, 2025. Government officials argue that the shift will help curb misuse, reduce idle travel time, and rein in skyrocketing public spending in the sector. In 2024 alone, transportation costs for the health system reached an eye-watering €6.74 billion. Of that, €3.07 billion was allocated to contracted taxi services—an astonishing 45% increase compared to 2019. For the Ministry of Health and Finance, the numbers are unsustainable.
But for many on the ground, especially small operators in rural or underserved regions, this reform is less about budget control and more about survival.
“This Could Ruin Us”
For drivers like Yves Rubicondo, a taxi owner in Pithiviers (Loiret), the reform could be devastating. Rubicondo runs a modest business with three employees and says a staggering 95% of his revenue comes from transporting patients under agreements with the national health insurance. Based on preliminary figures and simulations of the new pricing system, he estimates losing up to 30% of his annual income.
“It’s not just a line on a budget sheet for us,” Rubicondo explained. “It’s how I pay my drivers. It’s how I put food on the table. These changes don’t just tighten the belt; they pull the rug out from under our feet.”
His story echoes across the taxi community. At a recent protest near Gare du Nord in Paris, a driver who had traveled from the Lyon region voiced even more dramatic concerns. “What CNAM is proposing might seem viable on paper, but for us it’s impossible to adapt overnight. Personally, I’m looking at a 60% drop in revenue,” he said, standing amid a sea of honking cars and waving banners.
The main fear is that the new structure, aimed at minimizing unprofitable trips—especially those with long waiting times or return journeys without passengers—will disproportionately affect drivers in rural or suburban areas. In those regions, distances are longer, patients less frequent, and waiting times outside clinics and hospitals are often unavoidable.
Escalating Mobilization Across France
What began as localized resistance has now grown into a coordinated national movement. Over the past week, thousands of taxi drivers have taken to the streets in multiple French cities. Key railway stations and airports have been targeted in so-called “operation escargot” slow-driving demonstrations, as well as full blockades, turning parts of Paris and other cities into logistical nightmares.
Boulevard Raspail in Paris has become the symbolic epicenter of the protest. Just a stone’s throw from the Ministry of Transport, the area has echoed daily with blaring horns and even fireworks. The atmosphere, while largely peaceful, has occasionally turned tense. Law enforcement has had to step in on several occasions, leading to the arrest and prosecution of at least four demonstrators in the capital.
As the week wore on, frustration among drivers intensified—not only at the proposed policy but also at the government’s public stance. On Friday, government spokespersons reiterated that there were no plans to reverse course. “The reform is necessary and overdue,” one official stated. “The government remains committed to responsible, sustainable healthcare spending.”
That message has not been well received by the intersyndicale, the coalition of taxi unions leading the protests. The group is demanding not only the suspension of the reform but also the appointment of an independent mediator to facilitate further discussions. So far, those calls have gone unanswered.
A Broader Industry Battle
While the reform itself is focused on medical transport, the protests have exposed deeper, long-standing tensions within the French taxi industry—particularly with their competitors in the ride-hailing (VTC) sector. Taxi associations have long accused platforms like Uber, Bolt, and Heetch of undermining their work through questionable practices and loopholes in regulation.
In recent days, some protests have directly targeted VTC drivers, with allegations of “concurrente déloyale” (unfair competition) surfacing repeatedly in union statements and social media posts. Taxis argue that while they are bound by strict regulatory frameworks—including licensing, pricing, and insurance obligations—VTCs operate with far more flexibility and fewer oversight mechanisms.
The Interior Minister, Bruno Retailleau, who oversees transportation regulations including those covering taxis and VTCs, responded swiftly to the rising tension. On Thursday, he instructed law enforcement to intensify checks on ride-hailing vehicles. Officers were told to enforce three newly established fixed-penalty fines for VTC violations, including unauthorized passenger pickups, working without a booking, and failing to register properly with VTC databases.
Retailleau emphasized that “the integrity of regulated public transport systems must be protected,” adding that both taxis and VTCs must operate under “clear, enforceable, and fair rules.”
What’s Next?
The meeting scheduled for Saturday between union leaders and government officials—including Prime Minister Bayrou—is now seen as a crucial turning point. While the government has so far refused to consider retracting the reform, it may offer transitional measures, adjustments, or additional compensation mechanisms to ease the burden on taxi drivers.
One possibility is a phased rollout or pilot program that allows regions to test the new pricing model before national implementation. Another could be additional subsidies for drivers in low-density areas where the new rates might not be sustainable.
However, the unions remain skeptical.
“Negotiation is only possible if both sides are willing to move,” said a spokesperson for the intersyndicale. “We’re not here to destroy the healthcare budget. We just want a system that works—for the state, for the patients, and for the drivers who’ve been on the frontlines for years.”
For patients, especially those with chronic illnesses or living in remote areas, the outcome of this reform could also significantly impact access to regular medical care. If fewer drivers accept medical transport trips under the new rates, vulnerable populations could find themselves isolated.
Conclusion
The patient transport reform is more than just a financial issue—it’s a human one. It touches not only the bottom lines of small business owners but also the accessibility of essential healthcare for millions of French citizens. As France grapples with balancing fiscal responsibility and social equity, this crisis underscores a growing need for dialogue, transparency, and long-term planning in sectors where people—not just numbers—are at stake.
All eyes are now on the Ministry of Transport this weekend. Whether Saturday’s talks bring resolution or only deepen the divide remains to be seen.