“If the government wishes to disengage Health Insurance from long-term illnesses, the solutions seem few and unpopular”

2024-04-28 05:00:13

Are we heading towards an upcoming controversy affecting our health system? The government’s quest for savings to get public finances back on track is now pushing it to question the management of so-called “exempt” long-term illnesses (ALD), in order to reduce the associated expenses. A financial burden would then, in fact, be transferred directly or indirectly to complementary health insurance and to households. Blowing hot then cold, the executive is aware of moving forward in minefields.

The hunt for savings is on. On the 30 billion euros needed to complete the 2025 budget [10 milliards en 2024 plus 20 milliards en 2025], a significant portion will have to be released by Social Security, whose state of accounts continues to arouse criticism and concern. To achieve its goals, the government naturally questions the coverage of ALD, which represents 66% of expenses reimbursed by Health Insurance. It is therefore a major item of expenditure, which is also continuously increasing, which only concerns 18% of the covered population, the majority of whom are retirees.

If the government wishes to partially disengage Health Insurance from LTCs, the solutions however seem few and unpopular. Reducing the number of pathologies eligible for ALD is a plausible option, as was the case in 2011 with the exclusion of arterial hypertension.

More generally, more sober management of ALDs with, for example, the tightening of eligibility conditions and maintenance of rights is also possible. Finally, and it is easy to imagine the indignation that would ensue, the choice of public authorities might be to reduce health insurance coverage and consequently create a co-payment on everything or part of the acts.

Significantly affected households

A certainty is emerging: whatever the methods of action chosen, households will be significantly affected. Therefore, it is politically inconceivable to make them directly and publicly report this disengagement, at the risk of seeing their remaining expenses explode. The government would therefore opt instead for a transfer of costs to supplementary health insurance organizations (OCAM).

But asking them to assume this responsibility, when their technical results have been almost zero in terms of health for several years, would be insane. Supplementary insurance companies might in fact see their expenses increase by 20% to 40%, and would then have no other choice but to pass this increase on to the contributions of the insured. A strategy that is difficult to accept, but which might be carried out, with regret, by a government forced to adjust the budget for 2025.

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