At the request of the Senate, the Court of Auditors submitted a report on the CMU which advocates better control of the resources of beneficiaries.
It is a generous device, the merits of which are in no way called into question. But like many social benefits in France, the CMU must be reformed in order to last, according to a report of the Court of Auditors.
The Universal-Complementary Medical Coverage (CMU-C) has since 2000 allowed 5.2 million low-income people to seek free treatment. As for the Assistance for the Acquisition of Complementary Health (ACS), the other mechanism financed by the CMU, it has been offered since 2005 to 1.2 million providers.
“A major role for access to care”
These aids “deserve to exist” because they “play a major role for access to care for the most disadvantaged part of our fellow citizens”, summarizes Antoine Durrleman, author of the report of the Court of Auditors requested by the Senate for this. evaluation, whose comments are reported by AFP. They constitute “health shields against the creeping disengagement” of Social Security, he explained to the Social Affairs Commission of the Court of Auditors.
However, the management of these devices must be a matter of “diamond transparency”, insofar as they are financed by social insurers. In addition, their financial perspectives seem to be deteriorating due to the successive increases in the resource ceilings and the increase in the number of beneficiaries. If nothing is done, the CMU fund could be in deficit around 2017-2018, the Court is alarmed. According to Antoine Durrleman, if all the eligible ones asserted their rights, between 1.2 and 2 billion euros should be mobilized.
Better control of resources
“The question of legitimacy is as essential as the question of sustainability”, insisted the expert of the Court, who calls for an intensification of the controls of the resources of the beneficiaries, in order to verify that only the most deprived are included in this. device.
This approach has already been initiated by the CNAMTS (National Health Insurance Fund for Salaried Workers), which will launch a national control plan in order to track down social security fraud. This Wednesday, its director general, Nicolas Revel, announced that 400,000 requests for access or renewal to the CMU-C will be scrutinized each year, through bank data.
Simplification of procedures
In the end, the Court points to a “paradox”: “the public authorities have given more priority to the extension of the perimeter rather than the effective access of this population to rights”.
However, for the beneficiaries, it is necessary to simplify the procedures, explain the authors of the report, who stress that the conditions of instruction of the health insurance funds are “insufficiently secured”. Consequently, “the risks of anomalies and errors of financial significance for CMU-C remain significant”.
By the end of 2017, the insured will be able to submit his request for help online. The director general of the CNAMTS suggests moreover “to wait for the controls of the coming months to be able to conclude from the quantification of the phenomenon” of anomalies and to “distinguish what concerns the anomaly or the fraud”.
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