During the debate of the primary, in between the two towers to the right, Alain Juppe has accused his opponent of wanting to lower the rate of reimbursement provided by social Security. A measure of French prime minister François Fillon has a particular draw ire : this is the one that is to refocus the reimbursements from the sickness Insurance on the “serious conditions or long-term,” according to the terms of its program. The supplementary insurance would then be dedicated to other care. Should he see a way to opt-out health Insurance for the benefit of the add-ons (private insurers or mutuals) ?
Serge Grouard, the deputy of the Loiret in charge of the economic program of François Fillon, shows itself to be extremely careful. For him, this part still needs to be worked to be specified. But the reading of the report of the Court of auditors on the application of the laws of financing social Security 2015 gives an idea of the logic which could guide François Fillon on the subject. If the campaign team of the candidate has closed its program prior to its publication and had therefore not aware of, one of the tracks traced by the magistrates strangely similar to his proposal.
Clarify the respective roles of the Insurance and mutual
In the medium term, “write the report’s authors,” the field of intervention of the compulsory health Insurance could be reviewed. Health Insurance and complementary insurance are involved in jointly on a basket of care is reimbursable often wider than in other european countries. For the compulsory health Insurance, the goal might be, tightening up the basket of care is reimbursable, to reinvest in the areas that are most critical and better-financed medical progress “.
In the logic of the Court of accounts, the objective of such reform is to reduce the ” cost “, that is to say, what the patient pays out of his pocket, despite the involvement of health Insurance, either directly or through its contributions to a supplementary body.
A system that is apparently very protective
In 2015, the cost has reached to 44.3 billion euros on a total expenditure of $ 195 billion of care and medical goods, recalls the institution. On this ground, the $ 26 billion spend in the supplementary insurance and 16 billion are directly paid for by households.
In France, the share of health expenditure is borne by the sickness Insurance is therefore particularly high. Last year, it has reached 77 %. A figure that has been increasing since 2012, thanks in part to the policy of François Hollande.
leftover to load sometimes already very high
But this performance is mainly due to the continuous increase of patients with disease of long duration (ALD) – cancers, diabetes, high blood pressure, etc –, including the rate of support is higher than the average. In 2015, they accounted for over 16% of the population compared to only 11 % in 1999.
at the same time, the individual levels of reimbursement provided by the sickness Insurance are lower in reality for all the world, because of economy measures between 2003 and 2011 (deductible medical of 50 euro cents on the boxes of medicines, etc.) and of the multiplication of the exceedances of fees charged by the doctors (especially the specialists).
This remains to be borne by insured was 520 euros on average per year in 2012 before the intervention of the additional. But, for 5 % of them, it amounted to 2 750 euros on average per year ! In question, the hospital stays, more expensive for those who are forced to do so.
complementary to the role more and more important
” In the context of a gradual erosion of the level of support for individual policyholders – excluding situations of long-term medical condition by the compulsory health Insurance base, the socially insured rely ever more massively to private insurance are complementary, with the support of the public authorities, in order to reduce their exposure to risk remains at high capacity, ” notes the Court of auditors.
So the French system ranks already second in Europe for the space given to private insurers in the funding of health care expenditure after… Slovenia !
Finally, the direct participation of households in health expenses in France appears to be low. It has hit a low point in 2015, at 8.4 %. A very good news. Except that such a rise in the power of complementary health in the system promotes the increase of the exceedances of fees and rates (medical, dental and optical, in particular). It is also considered inequitable by the Court of auditors. The financial effort of households to pay additional increases strongly with age and peaks at the time where people have the highest risk of getting sick. The individual contracts of health care for retirees are more expensive than contracts and collective enterprise. And these latter are heavily subsidized, which weighs heavily on public finances.
A system of increasingly unequal
The conclusion of the Court of auditors is cold in the back. “The erosion hidden levels of reimbursement of health expenses by the mandatory health Insurance and the increase of the differences of treatment they will cause between the categories of insured persons compromise, without that these changes are clearly seen, the ability of social Security to ensure adequate protection and equitable against the risk of the disease. “
in the Face of such a finding, the judges propose a scenario similar to the proposal of French prime minister François Fillon. If it was applied, the health Insurance would focus on a limited number of care. It would come out as well completely expenses for optical or dental prosthesis, and a part of the transports, as in Germany since 2003 or in many other european countries. In exchange, the rate of reimbursement of health Insurance would increase sharply. The objective displayed by the Court of auditors is clearly” to improve the cost equity ” in access to care focusing on the health Insurance on a limited number of expenses.
Serge Grouard speaks, to him, to entrust to complementary all the little illnesses of everyday life such as colds. Remains to be seen whether François Fillon account ban, in the longer term, remains to charge high for patients by capping, as the committee also recommends that the Court of auditors.