The government issued the decree on the new content of responsible contracts. Health insurers fear that patients “are paying the price for a poorly initiated reform.”
The coverage by mutuals of excess fees for physicians will be limited. The same goes for optical expenses which will be supervised. These rules will come into force on April 1, 2015 under the so-called “responsible” health contracts. In this agreement, the government grants, on the one hand, reduced taxation to insurers and mutuals, on the other, these organizations undertake to respect criteria to lower certain health tariffs. But will this system really benefit patients or backfire?
Skeptical insurers
For Marisol Touraine, this device will lead to price regulation. Indeed, if mutuals do not meet the criteria, they will no longer benefit from tax advantages. Insurers give another story.
“In addition to the inflationary effects of the decree already reported by the Mutualité Française”, the French Federation of Insurance Companies (FFSA) and the Technical Center for Provident Institutions (CTIP) regret “the government’s choices to cap the coverage of health costs – doctors’ fees, optical expenses – in the new responsible contracts. “According to them,” the decree will lead to limiting the levels of reimbursement of French health costs insured by complementary. In other words, if the overruns of health professionals remain above the ceiling imposed by the State, it is the patients who will be out of pocket.
Towards two-tier medicine
“This route reduces access to healthcare for the French by leading them either to personally bear additional expenses during their medical consultations, or to give up seeking treatment”, say the organizations.
For them, “only the wealthiest among them will be able to decide to resort to additional insurance, or to bear increased out-of-pocket expenses to consult their doctor. “
The overruns beyond the security tariff persist
To support this thesis, insurers also conducted a survey that Le Figaro procured. According to the results reported, professionals will not change their habits. “Practitioners do not set fees based on contracts,” note these insurers.
The latter cite the example of a specialist who charges 100 euros for his consultation which will result in an outstanding charge of 55 euros for the patient, with a responsible contract whose reimbursement limit is capped at 100%.
And according to the FFSA, 47% of gynecologists exceed the threshold of 100% of the social security tariff. In the Paris region, this proportion climbs to 64% and one in five bills for its services more than three times the basic rate, concludes the daily.
According to Bernard Spitz, president of the FFSA, and Pierre Mie, president of the CTIP, “this reform of responsible contracts goes in the direction of inefficiency and injustice. Its main effect will be to heavily penalize the middle classes and to install two-tier medicine in France. “
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