“Usually our reports are more confidential”, recognizes Pierre-Jean Lancry, president of the High Council for the future of health insurance (Hcaam). But the publication, in the fall, of the first elements of a report evoking the creation of a “big Secu” had provoked an outcry. It drastically reduced the scope of complementary health insurance.
→ ANALYSIS. Health insurance: towards a “big Secu” without mutual insurance?
This project is however only one of the scenarios studied by the High Council, invited last July by the Minister of Health Olivier Véran to reflect on the inequalities of access to complementary health. “Nearly 96% of French people have access to complementary insurance, explained Monday, January 17 Pierre-Jean Lancry presenting to the Association of Journalists of Social Information the final report published on Friday. But there are still problems for the most precarious or seniors. »
The latter, for example, see their contributions soar upon retirement, when the employer no longer contributes to the contributions and age becomes a risk factor. It was therefore necessary to find solutions that the Hcaam explores in four scenarios.
No creation of regional supplementary schemes
One of them is indeed that of a “compulsory, universal and shared insurance”, this “big Secu”, which is so scary to mutual insurance companies and doctors’ unions. “It’s a model that can appeal, especially when you take into account the issue of management costs: by switching from two channels to one, you save money that can be reinjected elsewhere in the health system”, acknowledges Pierre-Jean Lancry. Retirees would be the big winners of this single tariff, with an average saving of €260 per year.
The Hcaam also scrutinizes with interest the complementary scheme of Alsace-Moselle, inherited from Bismarckian laws, a compulsory local scheme, managed by the unions. However, it notes that its generalization, like the creation of regional complementary schemes, would come up against constitutional obstacles. Another obstacle: the cost, with an increase in Social Security expenditure of 20 billion euros, increasing contributions by the same amount. No way for the government, which has since cautiously dismissed the idea.
The track of “improving the current architecture”
Another possible scenario: the increase in the rate of reimbursement of Social Security, for example with the abolition of the moderating ticket. But, here again, the risk would be an increase in contributions, mainly for companies and high salaries.
→ LIVE. “La grande Secu is in no way a social demand”
The Hcaam is also exploring the possibility of distributing the roles differently between Social Security and mutuals: “A disruptive scenario where Social Security and mutuals intervene on separate care baskets”, explains the Hcaam. This is the case in Canada where the private sector pays for care not covered by the Canada Health Act.(dental prostheses, hearing aids, glasses, etc.).
Finally – or rather first, because this is the first scenario studied – the Hcaam raises the question of a reform preserving the current architecture in a “to improve social security coverage by proposing simpler, fairer rules, and allowing better allocation of reimbursements between social security holders so as to strengthen solidarity between sick and healthy people”.
Towards a “health shield”?
At the same time, the idea of a “sanitary shield” is advanced, consisting of capping the accumulation of remaining dependents: beyond a certain annual sum, the care would automatically be covered 100% by Social Security.
“We do not favor any scenario: they have too different logics. None allows a consensus of the Hcaam”, warns Pierre-Jean Lancry, who recognizes that none of them solves either the basic problem of excess fees, city consultations or individual rooms in the hospital. However, these overruns now largely carry the seeds of the risk of a “two-speed health” put forward by those who criticize the “grande Sécu” project.
“Even so, there remains the question of unequal access to care for retirees and the precarious: and that is what our scenarios try to explore, he insists. None is better than another. It is up to politicians and candidates to instruct those who correspond to their strategic choices. »
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Who reimburses health expenses?
79.8% of French health expenditure is financed by Social Security. It was 76.3% in 2011. The increase was particularly strong between 2019 and 2020 (+ 1.9%) due to the health crisis, mainly covered by health insurance.
12.3% are covered by complementary health insurance (mutual or insurance), compared to 13.5% in 2011.
6.5% remain the responsibility of households (compared to 8.9% in 2011). The remainder to be paid is less than €240 per year for 50% of those insured by social security and exceeds €2,200 for 10% of patients.
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