Grandstand. The work of the High Council for the Future of Health Insurance (HCAAM), exploring a change in the relationship between Social Security and supplementary health insurance, were released on January 14. Neither the interests of certain actors nor the technicality of the subject should lead to burying these reflections. On the contrary, they must take a major place in the public debate, and particularly in the current presidential campaign.
Some findings of the HCAAM report are factual, and must be brought to the attention of the public to initiate reflection, then decision-making. Thus, it is observed that the management costs of the French health insurance system are the highest in Europe. This means that for a given health expenditure, it is in France that it is the most expensive for households.
However, regardless of the forms it takes, health expenditure is paid in full by the French: compulsory deductions (social security contributions on earned income – including the “employer” share –, CSG, etc.), contributions to complementary or remain dependent. In all cases, it is the households that pay. Reducing these management costs, which are much higher than those of our neighbours, thus appears to be an obvious way to reduce the overall cost of their healthcare expenditure without altering its quality or modifying its nature.
Global expenditure that is currently poorly pooled
Next, it is determined that the magnitude of these management fees – more than 15 billion euros per year – is mainly explained by the stacking of two payers for almost every health expenditure. Complementary today concentrate a larger share of these management costs than health insurance, with strong momentum due in particular to their competition to attract customers.
This stacking is also a source of indirect costs and inefficiencies, for example when the structural complexity of setting up third-party payment for city medicine leads to an increase in hospital emergency visits. These issues cannot be ruled out because of the categorical interest of such and such an actor: the financing of the health system must be as effective as possible in return for the effort it represents for our fellow citizens.
Finally, if not above all, this overall expenditure is currently poorly pooled between the French. The distribution of its burden is very favorable to employees of private companies, with collective contracts whose premiums are exempt from all taxation, and unfavorable to inactive people, in particular retirees. The latter are thus more at risk of not being well protected and therefore of giving up certain care, even though they are, on average, those who need it the most.
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