PTo reduce the public deficit, the government proposes to limit health spending, which in 2022 represented 11.9% of France’s gross domestic product (GDP), placing us in second place among European countries behind Germany (12.6%). But in euros per per capita, Germany spends on average 20% more than France (4,343 euros against 3,475 euros).
France, on the other hand, leads European countries in terms of administrative costs for health funders: 6% of health expenditure compared to 5% in Germany and 3% for the average of countries in the Organization for Economic Co-operation and Development (OECD) (“Tackling waste in health systems”, OECD, 2017).
In fact, specifically for France, we have double control for each treatment, by on the one hand a compulsory health insurance and on the other hand a supplementary private insurance. So much so that Supplemental Insurance spends 7.7 billion in administrative fees while reimbursing 13% of care, while Social Security spends 7.5 billion in administrative fees while reimbursing almost 80% of care. In other words, when an insured pays 100 euros for a supplementary insurance (mutualist or not), only 75 euros are used to pay for the care compared to 96 euros if he leaves it to the social security.
“Do better with less”
By lowering subsidies for consultations with a doctor or midwife from 70% to 60%, the government wants to reduce public expenditure by transferring it to private insurance. But they will automatically transfer the increase to the premium paid by their policyholders after an 8% increase as early as 2024. This purely accounting measure will therefore not result in any savings for the company. It will cost policyholders more and will cause an increase in social inequalities in the area of health to the extent that the less fortunate, especially among retirees, will be forced to downgrade the level of their health coverage.
Conversely, the integration of mutual companies in a “Grande Sécu” that reimburses 100% of a basket of prevention and solidarity, will allow society to save 5.4 billion euros per year, according to a report by the High Council for the Future of Health Insurance (HCAAM), published in January 2022 (“Four polar scenarios for the development of the relationship between social security and supplementary health insurance”). In the absence of this major structural reform, the creation of a supplementary insurance managed by the social security would make it possible to “do better with less”, at the request of the Budget Minister. The management of the compulsory health insurance and the supplementary health insurance by a single financier would make it possible to avoid unnecessary overlaps of administrative costs.
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