Survey – Presented as social progress, the reform of complementary health insurance could eventually lead to the establishment of multi-speed coverage.
Is the reform of complementary health insurance a threat to the French social protection system? Social Security continues to disengage in favor of private payers, who assume the reimbursement of a growing number of treatments, for city medicine, dental care, and medical devices. A sort of privatization of health risk management, which challenges economists.
“From the moment when the complementary protection becomes universal, it is difficult to see how it could not play a more important role in the coverage of the French, how it could not transfer loads to it. This can weaken the basis of the Social Security ”, underlines Claude Le Pen, professor of economics at Paris Dauphine.
Claude Lepen, economics professor at Paris Dauphine: “The dynamic at work is mixed. We entrust a service mission to private insurers, but we will also reduce their room for maneuver … “
However, the latter remains optimistic. For this specialist, the dynamic generated by the reform will certainly benefit the complementary ones, but in return the State will gradually regulate them, by standardizing the contracts. He also believes that the mutuals were not particularly demanding reform, which pushed them to make a great effort of reorganization.
A vision that contradicts Frédéric Bizard, one of the most critical economists of the reform. Meet.
Frédéric Bizard, why are you opposed to this reform?
The idea was to generalize the complementary to all, for the sake of equality. But a major social reform announced, we made a real fiasco. The reform is in fact absolutely not a carrier of equality or solidarity. We will widen the inequalities between employees, since you will always have large companies which, in order to pamper their employees, will keep quality collective contracts.
The other companies, which are extremely concerned about their charges, and for whom a euro is a euro, will offer the minimum, and therefore degrade collective contracts.
Frédéric Bizard, professor of economics at Sciences Po: “We will widen the inequalities between employees of large companies and others …”
We also widen the inequalities between employees who have access to collective contracts, and the self-employed, who have individual contracts. The latter will see the cost of these increase, to compensate for the low prices of complementary business. We are faced with an unequal, two-tiered healthcare system.
What are the long-term consequences of this reform?
We are now faced with two phenomena, which will continue and become more pronounced in the coming years. First, the state control of governance. With this reform, and with the Health Law, the State wants to take back in hand all the power that had been entrusted to the Health Insurance, in the form of a delegation of public service. Via the Regional Health Agencies, the State takes back the power of the organization of care, it already had it in the public hospital, but now it wants to have it on the other offers of care.
At the same time, there is a privatization of what is called “risk management”. We give the power to private funders to decide where the French will be treated, and with what protocols.
How can complementary health insurance exert such an influence?
They have this power thanks to the care networks, which will give them an increasing role in the future.
The problem is that the quality of care for people who cannot afford to extricate themselves from networks will decrease. The cardinal value of a healthcare network is a low price, and that is not synonymous with quality, since in this context, doctors will not be able to offer certain treatments or certain potentially expensive innovations.
Frédéric Bizard : “More and more contracts contain clauses involving healthcare networks. You reduce the quality of care, a low price is not always compatible with quality care … “
By relying on care networks, mutuals want to direct patients to the practitioners they have chosen for their low rates, and to become buyers of care in place of the latter. It means turning doctors into mere service providers.
Is there no way to counterbalance?
The problem with this sector is that it is absolutely unregulated. The offers offered by mutuals lack transparency and are not all posted on the Internet. Today, there is not a French person who is able to read a contract.
There is a prudential authority that exists, but it is only there to ensure the financial solvency of supplementary health insurance, it has no right to review the writing and content of contracts, for example. Strictly no effective remedy is possible if you feel that you have been wronged by your complementary health insurance.
Today, they are the big winners of this reform. They gain new policyholders, and will be able to offer them particularly profitable additional supplements. Along with healthcare networks, they play an increasingly important role within the healthcare system.
What solutions do you offer?
Removing complementary health insurance is unrealistic. I am rather proposing a system, where, instead of having two payers for each treatment, we would have one payor per type of treatment. Health insurance would reimburse certain well-defined benefits, the private payer for other separate benefits.
We would have a homogeneous, standard care basket managed by the Health Insurance and another care basket managed by mutuals. All French people would have to subscribe to it, and the guarantees provided would be decided each year by law.
We can imagine that there would then be two baskets of care, a collective financed by the Social Security, and an individual supported by private payers. In both cases, a standard homogeneous basket must be set up, the guarantees of which will be decided each year by law. Each operator is free to then offer additional services, which he deems useful.
Read the rest of our survey:
Health supplements: who wins, who loses?
Is the reform of complementary health insurance a threat to the French social protection system?
Posted by Why actor on Sunday 17 January 2016
Complementary #health : Who wins, who loses? Investigation of a 2-speed reform https://t.co/8ZZfGifvmU pic.twitter.com/prkOZHbIDd
– Pourquoidocteur (@Pourquoidocteur) January 17, 2016
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