2024-10-18 10:20:00
Analysis of Philippe Leducdoctor and health journalist, originally published on the Les Echos-Le Parisien website.
Is it the return of the “small risk” in health which deserves differentiated care compared to the “big risk”? This is the structural question posed by the social security financing bill which provides for the transfer of €1.1 billion from health insurance to supplementary insurance by increasing the co-payment on doctors and midwives.
20 years after the law of August 13, 2004 relating to health insurance, “basic law” which established new tools (shared medical file, attending physician, coordination of care, creation of the HAS, etc.) to remedy the deficit while improving the provision of care, medical control and governance, the government is changing its tune and simply deciding to transfer part of the deficit from Compulsory Health Insurance (AMO) to Supplementary Health Insurance (AMC) , without real structural logic. Just to reduce the Health Insurance deficit. A public expenditure becomes a constrained private expenditure.
The Social Security financing bill provides for “the increase in co-payment on doctors and midwives” from 30 to 40%, even if as the Minister of Health and Access to Care – Geneviève Darrieussecq – has indicated on several occasions – the modalities have not yet been defined. They will be during the debate in Parliament. The important thing is to save €1.1 billion. The only problem is that the co-payment has never modulated anything being covered for AMO policyholders.
Of course, this is not the first transfer. The latest, in 2023, of €500 million, was for dental care with (already) the co-payment which has increased from 30 to 40%. But, let us make no mistake, from transfer to transfer, the new government policy which, in fact, intends to distinguish the “big risk” from the small risk which will also be more borne by the insured through private expenses.
Indeed, the Bercy project which aimed to reform the regime of Long-term conditions (ALD) supported at 100% was abandoned, considered too unpopular because precisely concerning chronic pathologies, often disabling and costly. To save money, we do not touch chronically ill people but we target occasional patients.
This policy, which had been supported during the 2017 presidential campaign had been undermined because this distinction between “small risk” and “big risk” risks leading to a renunciation of care and caregivers know very well that behind a symptom that may seem innocuous can hide the beginnings of a more serious disorder that must be taken into account without delay to avoid a quiet deterioration and a loss of opportunity. The examples are numerous.
One might have thought that these transfers from AMO to AMC would be welcomed with open arms by the complementary health. But that’s not the case. They are up in arms against this decision because they see the trap clearly: “Transfers are part of a logic of a vessel communicating between public spending and private spending: they do not resolve the basic problem and do not respond to the need for structural reform. ” THE private insurers will have to increase their prices once again with the significant risk of discouraging many policyholders, the elderly, the unemployed and young people especially.
This is a break with the principles of Social Securitywho will celebrate his 80th birthday next year. The solution is not there. This is based in particular on prevention and the relevance of care, the implementation of which remains far too timid.
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