“For complementary insurance managed by Social Security”

2024-10-25 11:00:00

PTo reduce the public spending deficit, the government proposes to curb health spending, which represented, in 2022, 11.9% of France‘s gross domestic product (GDP), placing us in second place among European countries behind Germany (12.6%). However, in euros per capita, Germany spends on average 20% more than France (4,343 euros versus 3,475 euros).

France, however, is first among European countries in terms of management costs of health financiers: 6% of health spending, compared to 5% in Germany and 3% on average in the countries of the Organization for Co-operation and Economic Development (OECD) (“Fighting waste in healthcare systems”OECD, 2017).

In fact, specifically for France, we have double management for each treatment, by the compulsory health insurance, on the one hand, and the complementary private insurance, on the other. So much so that complementary insurance spends 7.7 billion on management costs while reimbursing 13% of treatments, while Social Security spends 7.5 billion on management costs while reimbursing almost 80% of treatments. In other words, when an insured person pays 100 euros to a complementary insurance (mutual or otherwise), only 75 euros are needed to pay for treatment compared to 96 euros if he entrusts it to Social Security.

“Do better with less”

By reducing the reimbursement for medical or obstetric visits from 70% to 60%, the government wants to reduce public spending by transferring it to private insurance. But they will automatically pass on the increase to the premium amount paid by their policyholders, after an 8% increase already in 2024. This purely accounting measure will therefore not lead to any savings for the company. It will cost the insured more and will cause an increase in social and health inequalities to the extent that the less fortunate, particularly among pensioners, will be forced to reduce the level of their health coverage.

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On the contrary, the integration of mutuals into a “Grande Sécu” that reimburses 100% of a basket of prevention and solidarity assistance would allow the community to save 5.4 billion euros a year, according to a report by the Superior Council for future of health insurance, published in January 2022 (“ Four polar scenarios for the evolution of the relationship between social security and complementary health insurance “). In the absence of this major structural reform, the creation of a complementary insurance managed by Social Security would allow “do better with less”, according to the wishes of the Budget Minister. In fact, the management of compulsory health insurance and complementary health insurance by a single financier would make it possible to eliminate unnecessary duplication of management costs.