Long-term ailments should affect 20% of French people in 2025. A Treasury study plans to cap reimbursements.
Alzheimer’s, Parkinson’s, multiple sclerosis… the list of long-term illnesses (ALD) is long. Patients suffering from these serious, long pathologies (more than six months) are however covered 100% by health insurance. As a result, the expenses of people with ALD now represent a preponderant share of reimbursed health expenses (90 billion euros in 2011). And the ALD device costs 12.2 billion euros to Health Insurance, on a budget of about 170 billion, calculated the Directorate General of the Treasury in a study published this Friday.
20% of the population in ALD in 2025
Worse still, “due to the aging of the population and the development of chronic diseases”, the authors of this work estimate that reimbursed health expenditure would increase, according to the projection carried out, by 1.6 percentage points of GDP in fifteen years to reach 8.3% of GDP in 2025. This increase would come equally from the aging of the population and the increase in the prevalence of chronic pathologies. “The share of people in ALD would thus increase from 15.4% of the population in 2011 to 19.7% in 2025”, it is written.
Inequalities of treatment
In addition, the ALD device generates inequalities in treatment between patients and can leave them with high out-of-pocket expenses. On the one hand, because of its medical approach, rather than economic (French specificity), the ALD system can lead to two insureds facing similar health expenses ultimately benefiting from very different reimbursements if one is exempt under ALD and the other is not. On the other hand, it only partially achieves its objective of limiting patient out-of-pocket expenses since one in twenty insured spends more than € 900 per year (excluding overruns and coverage by complementary health insurance) in medical care and goods. Patients with ALD, who represent a third of this population (almost twice as much as their share in the total population), remain at the mercy of large out-of-pocket expenses for consumption unrelated to their ALD.
Reduce the number of pathologies covered …
Faced with this assessment, the Treasury concludes that “as the ALD system suffers from significant limitations, it should be modernized to ensure its sustainability”. For example, it proposes to reduce the number of pathologies covered by the ALD system. The withdrawal in 2011 of severe arterial hypertension from the list of ALD, “except in cases of proven clinical severity”, created a precedent for this approach. However, it should be noted that it was motivated by the fact that hypertension is a risk factor and not a disease. “This track can only be considered if the withdrawal of a pathology is justified for medical reasons”, specifies the Treasury.
… or cap reimbursements
In addition, the Treasury proposes to fix the level of reimbursement of the Health Insurance according to the expenses of the patients, and no longer according to their pathology, as is the case for the ALD. The bill payable by a social insured could not therefore exceed 570 euros, the Health Insurance taking any additional expenses at its expense. A system which according to the Treasury has the advantage “of placing all the French in the same boat and can be adjusted according to budgetary constraints.” The authors of the study admit, however, that some patients in ALD, who suffer an annual out-of-pocket expense of less than 570 euros, would lose.
Marisol Touraine defends the ALD system
According to Le Figaro, Marisol Touraine, “took note of this proposal with surprise”. “This proposal does not correspond to what the minister is doing, or to what the minister thinks,” says one in the entourage of the Minister of Health, and “there is obviously no question of calling into question the ALD system ”.
The daily claims to have obtained the same story in the cabinet of Michel Sapin, Minister of Finance. “It is an administrative study which only engages the administration of the Treasury and not the ministers, there has never been a project in the matter”, declared a spokesperson. Moreover, the public health law and the national health strategy are under discussion, this has never been mentioned. “
.
