Are we in for transferring more of the burden of healthcare costs to the "organismes complémentaires" ?

Last autumn and early winter we were pre-occupied with proposed measures to withdraw healthcare from those who had taken early retirement and came to live in France.  For the vast majority of you your situation has now been clarified. Although this topic concentrated the mind there were other things going on in the background.

A major theme of discussions has been the transferring more of the burden of healthcare costs to the "organismes complémentaires", the insurance companies, mutuelles, and provident institutions.  These outfits still only cover around 13% of total healthcare costs.  One of the suggestions was that they would share some of the costs of treatment for those with long term conditions "Affections Longues Durées" (ALD). Presently, of course, the "Sécu" gives 100% cover.  Approximately 10% of the population are treated for ALD but takes up around 40% of the health budget.

We all know how the UK media; newspapers and BBC distorted the facts about thousands of Brits receiving so called "free" healthcare in the autumn and the distortion continued with a report from the BBC Paris correspondent.  She suggested those with ALDs and had their regular medication covered 100%, would have this reduced to 35%. Those with ALDs also receive 100% cover for "comfort" drugs which normally only attract a reimbursement rate of 35% and it was only proposed that ALD patients would have to pay more for these comfort drugs.  It was not intended that a diabetic, for example, would have only 35% cover for insulin.

For the time being contributions from the "organismes complémentaires" to ALD costs have been shelved but for how long?  The fundamental problem continues to be the ongoing health budget deficit.  This has been gradually reducing but still forecast to be 4 billion Euros in 2008.  It was decided politically inexpedient to increase the rate of CSG or to increase the "ticket modérateur".

The "organismes complémentaires" have however been targeted and with effect 1 January 2009 a new tax will be levied on their turnover ("chiffre d'affaires").  This is an attractive option for the government as their total turnover has increased from 17.5 billion Euros in 2001 to over 27 billion Euros in 2007.  The health minister has stated that this should not lead to an increase in premiums as since 2001 the "complémentaires" have taken between 3 and 4 billion Euros more in premiums than they have made in reimbursements during this period.  Plausible perhaps until one of AXA's finest, their technical health director, stated that it would be passed on to the client and possibly reducing policy benefits.  We will see.

Initial reaction seems to be one of anger from the insurance companies but the reaction of the "mutuelles" a little more measured.  The latter were relieved that the "ticket modérateur" had not increased.  It will be interesting to see if the "mutuelles" do absorb this tax increase themselves, although the premiums/claims ratio are similar for mutuelles and commercial insurers.

Finally, GPs have for some time been pressing for an increase to 23 € for a consultation and the issue is still resolved.  The doctors' representatives meet with the "Caisse Nationale Assurance Maladie" (CNAM) again in September. 

Peter Owen
http://expathealthdirect.co.uk 

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