Tribune. During the health crisis, so that new care (tests, vaccination, telemedicine, etc.) could be quickly accessible free of charge to the entire population, it was decided to have them covered 100% by Social Security alone. For the sake of agility, we avoided the complexity of the usual two stages of financing, Social Security then additional insurance.
At the same time, the implementation by the government of “100% health” has allowed hundreds of thousands of French people to access expensive care, especially dental and hearing, with a zero charge. This government reform comes in response to the obvious failure of the complementary “care networks”, which have never succeeded in providing access to this care for the poorest, while greatly reducing the users of these networks. freedom of choice for their opticians, dentists or hearing aid professionals.
It is in this context that the Minister of Health, Olivier Véran, asked the High Council for the future of health insurance (HCAAM), so that a reflection on the link between health insurance and health insurance can be carried out.
Four scenarios are studied, including that of the “great Security”. This provides for the coverage by health insurance alone of most of the care covered by the complementary, and this in particular to avoid the double financing of the same care, generating management costs among the highest. countries of the Organization for Economic Co-operation and Development (OECD).
Strong differences
While it is true that the current system provides the lowest average remainder for healthy households in OECD countries, this average hides large differences between categories of users. The public statistics department defines the effort rate as the sum of the health insurance premiums paid by the household and the remainder to be paid after the intervention of the complementary, divided by the household income.
The effort rate of the poorest households is equal to 10% of their income, then decreases when income increases to represent less than 2% of the income of the wealthiest households. In addition, the effort rate increases with age: if it is 3% of their income for working people, it rises to 6% for 66-75 year olds and 7% for those over 75 years old. Supplementary premiums are doubly unequal, at the expense of the poorest and the oldest.
If, for the better-off, the cost of the complementary is therefore not a subject, it is quite different for the most modest (retirees, but also students and the unemployed), who, moreover, must pay all of the costs. health insurance premiums while private sector employees are covered by a collective contract half-financed by their employer. However, it is the poorest who have the most degraded states of health and who therefore need the most care.
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