The Minister of Health pleads for a strengthening of the role of health insurance in the reimbursement of care. A project that worries health mutuals.
It is the project which gives cold sweats to complementary health. And who could animate the debates of the presidential campaign. To put an end to “the structural weaknesses” of the current health system, Olivier Véran, last summer asked the High Council for the Future of Health Insurance (HCAAM) to study the project of a “Grande Sécu”. “.
The idea defended by the Minister of Health is to extend the scope of intervention of Social Security in the reimbursement of care, to the detriment of mutuals. Today, Social Security takes care of 75% of health expenses, against 15% for supplementary expenses. The remaining 10% is borne by the patient.
In its most radical formula (several avenues are being considered, with a greater or lesser degree of strengthening of the role of the Social Security), the reform would lead to a kind of nationalization of the health system in which almost all of the care eligible for reimbursement would be covered by Health Insurance alone.
What objectives?
If Olivier Véran pleads for the “Great Security”, it is to put an end to the extreme complexity of the current system. Today, in fact, an act can give rise to two reimbursements: that of the health insurance and that of the mutual.
The other pitfall of our health care system pointed out by the minister is its lack of fairness. Retirees, for example, are forced to take out an often expensive individual contract in order to be covered by a mutual, without benefiting from any additional advantages.
On the contrary, employees benefit from a less expensive company mutual insurance company thanks to the pooling of risks and with generally higher reimbursement levels. There is also the situation of the unemployed who are more likely to give up complementary health care, and therefore care, because they simply do not have the means to afford one.
The government also denounces the high level of premiums and management fees for complementary organizations. These represented 7.5 billion euros in 2018, according to a report of the Court of Auditors. This is a level slightly higher than that of Social Security (7.3 billion), whose current health expenditure is however six times higher (162.66 billion euros against 27.9 billion euros).
What funding?
According to figures from the High Council for the Future of Health Insurance revealed this Friday in The echoes, the “Grande Sécu” project would represent 22.4 billion euros in additional public expenditure. To finance it, the HCAAM imagines an increase in employer contributions or the CSG.
For Eric Heyer, director of the analysis and forecasting department at the OFCE, logic would dictate that this “Great Security” which would benefit everyone is financed by a tax paid by all, and therefore by the CSG, rather than by contributions.
“Is it up to companies and employees to finance all of this? Or is it not rather a tax? Since everyone has the right to it. Since what we want? is that everyone is well looked after, whether they are a retiree or a child, whether they have contributed or not. (…) Let’s take out the contributions. make work more attractive “, explains the economist.
However, increasing the CSG is not an easy measure to take. Emmanuel Macron knows something about it: during the yellow vests crisis, the head of state ended up going back on the increase in the CSG decided at the start of his mandate for retirees receiving more than 1,200 euros per month, finally setting the threshold at 2000 euros.
What savings?
According to The echoes, the reform would not have a negative impact on the purchasing power of households since they would no longer have to pay their insurance premiums. Better still, the project would even make 5.4 billion euros in savings on the current management costs of mutual health insurance.
What future for mutuals?
If it were to see the light of day, the reform of the “Grande Sécu” would not sign the death of mutuals which could continue to cover some expenses such as private rooms in the event of hospitalization. Complementary organizations also carry out other activities such as provident insurance. They may also continue to offer additional supplements so that the patient has no out-of-pocket expenses, or to reimburse certain acts not covered by Health Insurance.
Not enough to reassure the mutuals which remain fiercely opposed to the project and denounce the arguments of the executive. La Mutualité française explains in particular that the increase in contributions does not have a lucrative logic but that it is only the result of the increase in health expenditure of the French.
“The aging of the population, increasingly costly care due to technological innovations, development of chronic diseases: mutual contributions have always evolved at the same rate as the services they provide, ie 3% per year on average between 2006 and 2018 “, notes the professional union of mutuals in a press release.
In addition, mutuals, “in a competitive environment, but also anxious to preserve the purchasing power of their members, have no interest in increasing their contributions”, continues the French Mutuality. Finally, and unlike Social Security, a mutual must balance its accounts. “They do not have the latitude to be able to resort to debt. An indebted mutual is a mutual which will be placed in liquidation by the supervisory authorities,” recalls the union.