“Grande Secu”: who would win?

According to the work of the High Council for the future of health insurance, the extension of health insurance, to the detriment of the complementary, favored the elderly.

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Who would win if social security reimbursed more care? This is one of the issues explored by the High Council for the Future of Medicare (HCAAM) in a report that must be made public by a few days and that Le Monde could consult in its quasi-definitive version. The responses made by this advisory body are cautious and assorted by several grounds: they suggest that impact could be beneficial, especially for retirees. However, this scenario of a “big security”, which has resurfaced for several months in the public debate, is unlikely to be resumed in the state, because of the hostility it inspires to many actors of the sector.

It’s now more than a year since the HCAAM conducts work on “the articulation” between compulsory health insurance and complementary organizations (mutual, insurance, provident institutions). His reflection resulted in a first series of tracks, that Olivier Véran asked him to deepen, in July 2021. The Minister of Health claimed an additional expertise, including the scheme of an extension of the perimeter of Medicare, which has been interpreted as a wish on its part to privilege this hypothesis – which the person concerned has defended, in public.

At present, social security covers nearly 80% of health expenditure. For their part, the mutuals, insurers and provident institutions intervene in addition, very often on the same benefits, by taking, for example, the exceedances of fees and the moderators – this fraction of fresh that is incumbent upon patients.

Strong disparities

This two-storey organization is “too complex” and “unequal”, in the eyes of HCAAM. In addition, it “does not guarantee the financial accessibility for all to essential care”, despite its cost that is high. One of the big defects in the system is the heaviness of “management fees”, France is “in the second rank” of the countries of the Organization for Economic Cooperation and Development, behind the United States.

Successive reforms have, certainly, allowed to offer a complementary to almost all of the population (96%) but this situation is accompanied by strong disparities. Collective contracts, which cover private employees, give often better and less expensive protections than individual insurance, very frequently contracted by seniors. As for jobseekers, they are less well treated than others, 13% of them have no complementary health.

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/Media reports.