2023-06-16 18:01:14
Mutuals knew that they would be put to use as part of the major oral prevention plan promised by the government. But not in the proportions made public, Thursday, June 15: the management of Social Security informed complementary health insurance that the coverage of dental care by Medicare would increase from 70 to 60% from 1is october. Charge to mutuals, insurers and provident funds to compensate for this reimbursement, estimated at 500 million euros per year.
An effort confirmed and defended in the wake of the Ministry of Health, which presents it as a lever for financing a major plan for the development of oral prevention, the objective of which is to see the growth of a “first generation zero cavity”. “The idea is that the savings generated [pour l’Assurance-maladie, dans le volet remboursement] can be quickly reinvested, with a transfer from curative to preventive”justifies the ministry.
The complementary knew since the fall that they would be solicited. But the amount mentioned at the time, in the context of discussions on the 2023 Social Security financing bill, did not exceed 300 million euros annually.
“We regret the method”
Since then, discussions have been held with the Minister of Health, François Braun, his ministry and Social Security, in particular within the framework of the dialogue committee with complementary organizations (CDOC), launched in October 2022. Social Security finally decided, more severely than announced.
“We regret the method, with a unilateral decision, and the substance, with a short-term choice, purely accounting, and above all not likely to meet the health challenges of tomorrow, from medical deserts to the aging of the population”, breathes Eric Chenut, president of the National Federation of French Mutual Insurance (FNMF). The measure did not please the caregivers any more. In a press release published on June 16, Les Chirurgiens-Dentistes de France, the leading trade union in the profession, sees only one “state disengagement” : “This unilateral decision suggests that oral health does not occupy the same place as general health for the government. »
In “disengagement” in “economy measure”swears the entourage of Minister François Braun, who says he is guided only by a “need for joint efforts [en faveur de la prévention bucco-dentaire] between compulsory and supplementary health insurance.
“Inevitable” increase in contributions
The Ministry of Health goes even further: the increase in the moderating ticket – the rest to be borne by mutual insurance companies or the patient after reimbursement by Medicare – “does not generate additional costs for the insured”. More exactly, “the idea is that it does not translate into an increase in contributions, especially in a period marked by inflation. The government wants it and encourages it”. Mutuals, they doubt it.
Industry representatives do not see how the measure could not be passed on to patients. “It is even inevitablewarns Eric Chenut, simply in the name of the financial sustainability of mutuals. Some mutuals are barely balanced, others not really. » Mr. Chenut now estimates at 700 million euros per year the increase in health expenditure to be absorbed by complementary health insurance, the structural increase in the number of acts in addition to that of the co-payment. ” And it’s not over “he warns.
The Medicare and the unions of dental surgeons are still negotiating the future tariff agreement, hoped for in July, with undoubtedly a rise in costs at the key for the complementary ones. Negotiations are also taking place on the side of midwives, others are just beginning among nurses and paramedics.
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What to make “impossible”, for mutuals, maintenance of contributions as they are. Or even strain relations between the government and the mutualists? In April, the FNMF judged “unsuitable” Emmanuel Macron’s promise of full reimbursement for wheelchairs in 2024. “I’m not sure that the financial situation of all complementary health insurance is maddening”had swept away the Prime Minister, Elisabeth Borne, inviting mutuals to “don’t scream before it hurts”.
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