Florence Jusot is professor of health economics at Paris-Dauphine University. With the College of Health Economists, she participated in the collective work The French health system today. Issues and challenges (Eska, 2021). This health expenditure specialist recalls that the deductibles on prescribed medicines, established fifteen years ago and the increase of which was defended by the Head of State, Emmanuel Macron, this Tuesday, January 16, do not affect the the same way for all patients.
After several months of hesitation, Emmanuel Macron has just positioned himself in favor of an increase in medical deductibles, these sums which, for each box of medicine purchased, remain the responsibility of patients, and which could go from 50 cents to 1 euro. Are you surprised?
Not that much. Health spending is increasing, and faced with this trend, public authorities today, exactly as in 2008 with the creation of franchises, under the presidency of Nicolas Sarkozy, are talking about “empower” the patients. However, this message seems quite ambiguous to me. It diffuses a suspicion of “overconsumption” of care. But in relation to what? At an average? Has a medical standard? Some patients certainly consume unnecessary care, but we also know that there are late recourse to the healthcare system, poor follow-up, refusals for financial reasons, etc. And therefore “under-consumption”.
The growth in health spending is not necessarily a sign of a dysfunction: it is also explained by the aging of the population and therapeutic innovation. The challenge is to find new sources of financing: that is the challenge for the government.
Are these deductibles specific to the French healthcare system?
They are found in many other countries – Switzerland, the Netherlands, the United States… But deductibles have, in France, their specificity: a very small amount applies to all patients – or almost – and concerns all the care received: on medications, therefore, but also on consultations. [qu’on appelle “participations forfaitaires”], on medical transport… These deductibles are added depending on the care received. In most countries, the system works differently: the patient must pay the first 150 or 200 euros of health expenses of the year which are not reimbursed, before being covered for the rest of their annual expenses. A bit like a car franchise, whose name has also been adopted. The name thus covers very different realities.
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