People with long-term illness (ALD) such as diabetes, cancer or HIV benefit from 100% social security coverage. But these patients are in reality not exempt from medical expenses. The Citizen Observatory of Out-of-Pocket Health Costs is today publishing a study on the health expenditure of these people benefiting from the ALD scheme, i.e. one in six French people.
At equivalent age and sex, a patient in ALD will cause an expenditure of 6300 euros per year for his health costs, against 1800 euros for other people. Their costs are covered respectively up to 88% and 63% by health insurance. People in ALD must therefore pay 752 euros on average, against 673 euros for others. According to the Observatory, this “proves that this system globally plays its role”.
A “safe” tariff not always adapted
Social security assigns a specific rate to each act of care. For ALD patients, it reimburses care at 100% of this rate. But this does not prevent the costs for the patient. Certain acts are in fact considered to be poorly valued, with a social security tariff lower than the actual costs of the practice. These include, for example, optics, dental care or hearing aids. Reimbursement by health insurance also does not take into account excess fees or deductibles. This problem concerns all insured persons, but unlike “ordinary” patients, people on ALD need more care, they also consult more often.
Expenses not reimbursed by social security are partially covered by complementary health insurance (between 36 and 89% of the remaining cost), but these contracts represent a cost for the user, especially if they take reinforced options for optical and dental care. Especially since long illnesses often have an impact on professional careers and income. In the end, people on ALD are less likely to have recourse to the most expensive care in terms of out-of-pocket care.
Also to read
Fibromyalgia, soon recognized as an ALD
Medicines: towards the end of the reimbursement rate at 15%
Smoking cessation: 150 euros reimbursed by social security
