“The health financing system risks imploding in 2024 in France”

2024-01-08 14:30:08

Contributions to supplementary health insurance will increase on average by 8.1% in 2024, according to a survey carried out by the French Mutualité. That is to say an additional withdrawal of 3.3 billion euros from the portfolio of policyholders. Suffice to say that the financing of our complementary health insurance risks being problematic this year, in particular for millions of middle-class retirees.

In the short term, the government has leverage to stop this inflationary spiral, by reforming contracts called, rather wrongly, “responsible and supportive”, keystones of sector regulation. But in the medium term, it will probably be necessary to act on the distribution of roles between public and private insurance to make health financing efficient and sustainable.

Almost all developed countries have a national public financing system, financed either by social insurance (Social Security type) or by the State (National Health Service type, in the United Kingdom). Added to this is a private insurance system, in addition and not in addition. Except in France, where private insurers have a complementary rather than additional operator role.

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This choice was forced rather than chosen, due to the preeminent place of mutual societies before the establishment, in 1945, of Social Security. France thus persists in attempting mimicry between two systems whose economic and social logics are nevertheless opposed, which can only lead to current failure.

Financial performance or healthcare coverage

Private financing is in fact regressive, because it is not linked to income: the more the system expands, the more it penalizes the middle classes. Supplementary health insurance reimburses 30 billion euros out of the 50 billion in expenses not reimbursed by Social Security, certainly making France the country where the final remainder is borne by households (7.2% of total expenses, according to the 2022 national health accounts established by the Directorate of Research, Studies, Evaluation and Statistics) is half that of, for example, the OECD average (a little less than 15%). But is the final objective to achieve this financial performance, or to ensure quality health risk coverage at a lower cost, particularly for the middle class? And there, France is very badly placed.

Indeed, the main obligation of so-called “responsible and solidarity” contracts, established by the law of August 13, 2004 and which alone represent 96% of private health contracts, is the reimbursement of user fees. However, this market of 21 billion euros, according to the 2022 national health accounts, has no real insurance value for the insured. Because most of the risks lie in the other components of the remainder, which are very poorly covered.

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