ALD (Long-Term Illnesses) are illnesses covered 100% by Health Insurance. But this essential advantage for patients is called into question by the government. Why Doctor looked into the matter.
- Around 20% of French people benefit from an ALD (Long-Term Affection).
- To be eligible for an exempt ALD, you must have a serious and/or chronic illness that requires long and expensive care (the criteria are specific and precise).
- There are 3 types of so-called exempt ALD. The ALD 30 included in a list which contains the names and characteristics of 30 diseases. ALD 31 concerns pathologies not appearing on the list. And ALD 32 is related to the accumulation of several pathologies which lead to a disabling pathological state (or polypathology).
These are economic motivations which seem to have prompted the government to think about the care of people in ALD, that is to say suffering from illnesses whose severity and/or chronic nature requires long and expensive care. This decision is therefore of great concern to patient associations and doctors’ unions.
ALD: 20% of French people concerned
Frédéric Valletoux, Minister Delegate in charge of Health and Prevention, declared in the National Assembly end of February 2024: “You know that long-term conditions concern 20% of our fellow citizens, that is to say 13 million French people who are thus supported in their pathology. This represents two thirds of reimbursements by Health Insurance. And therefore, It is not illegitimate or illogical, as has been done regularly, to question the relevance of these devices.“Then adding:”However, the list of ALDs dates from the 1980s“, recognizing wanting”question the relevance of these devices taking into account medical progress”. While in the newspaper The worldthe Minister of the Economy Bruno Le Maire wonders on “the drift in expenses linked to ALD“.
With an annual deficit in the health branch of Social Security constantly increasing, the government is looking to make savings. And in the viewfinder, the coverage of ALD (Long-Term Conditions), a solidarity system allowing 100% coverage (except flat-rate contributions, medical deductibles, hospital packages, excess fees) by Insurance Disease with pathologies requiring prolonged and expensive treatment.
ALD: constantly increasing
However, ALD being continuously increasing due to the aging of the population but also lifestyle habits, the expenses related are also. Indeed, between 2015 and 2020, the number of people treated for a long-term illness (ALD) increased by 2.6% per year on average.
After having doubled medical deductibles and increased the fixed contributions on consultations and medical procedures, it is now the relevance of the ALD system that the government is questioning.
ALD: major support but significant remaining costs
Recognition of ALD by social security is possible if you suffer from a serious illness, which has been ongoing for at least 6 months, and requires expensive treatment. It allows coverage of health costs linked to your illness, within the limit of the maximum reimbursable by Social Security (Social Security reimbursement basis). We then speak of exempt ALD. But be careful, certain costs, sometimes relatively high, may remain at your expense.
Diseases which can be taken in ALD must be registered in a painting where 30 diseases are listed including multiple sclerosis, amyotrophic lateral sclerosis (ALS or Charcot disease), cancers, cystic fibrosis, severe heart failure, hemophilia, severe epilepsy, dementia. Hence the name “ALD 30”. And if your illness is not on this list, it can be granted under ALD called “31” or “off the table”, such as severe endometriosis. There are also “ALD 32” which concern the accumulation of several pathologies responsible for a disabling pathological state (or polypathology).
These exempt ALD are granted, according to certain criteria, by Social Security regardless of the affiliation regime (General regime, MSA, etc.).
And even if there are still many elements that patients are responsible for, this system is essential for appropriate and complete care.
ALD: an open letter written by 25 associations
Thus, fearing a significant challenge to this system by the government, 25 associations, including Rose-up, Renaloo And Networked patientssent a open letter to the Minister of Health. They intend to discuss with the government in order to provide a road map that meets the needs of patients, specifying that “the lives of chronically ill people cannot be debated and decided without them.” They therefore ask to “Please receive them as soon as possible, so that a real consultation can begin with and for the patients”.
We must not forget that the average out-of-pocket cost of patients on ALD is already relatively substantial and represents almost double that of people who do not benefit from an ALD. These patients are, moreover, often forced to reduce or stop their professional activity, which considerably reduces their financial means. Altering or removing their care would only harm them.
