Will we have to pay more for a pair of glasses, crutches or hearing aids? This is in any case one of the serious avenues being considered by Bercy via the General Inspectorate of Public Finances (IGF). The latter published yesterday evening a report in partnership with the General Inspectorate of Social Affairs (IGAS) and handed over to the outgoing government. The target? Medical devices, which cover a wide range of areas, from dressings to heavy biomedical equipment, including prostheses and diabetes control.
Health: France puts 170 million euros on the table to accelerate prevention
The cause is health insurance spending on these devices, which has increased by 3.7% per year since 2017, reaching 14 billion euros in 2022. The report estimates that this is primarily an effect of the increase in volumes and, secondly, an increase in their price. In addition to stricter prescriptions and better price control, the two institutions are asking the French to dig into their pockets. In other words, a 1 euro deductible could be set up on medical devices, which are currently exempt from this payment. As a reminder, the deductible constitutes a remaining charge not taken into account by social security or mutual insurance companies.
This last one ” would generate savings of 259 million euros if it were subject to a new specific ceiling of 50 euros for medical devices, and 380 million euros if this ceiling were shared with the franchise on medicines “, the report says.
By the end of March, the government had already doubled all medical franchises applied, namely on medicines, paramedical acts and medical transport.
Increase in the remaining charge
Another increase that could be added to the deductible: that of the co-payment. The latter corresponds to the remaining charge to be paid. An option that would, again, generate 370 million euros in savings. Above all, the IGF estimates that this charge will be distributed among more players since this paying part, often covered by supplementary health insurance, would be reflected in the contributions of employees as well as those of companies.
An idea that is not unanimous, particularly among mutual insurance companies:
“Rather than penalizing social security beneficiaries with accounting measures, we need to look for measures that question the “why” of spending and not just the “how” to reduce the cost for health insurance,” laments the Mutualité Française, recommending to look instead at “a better approach to prescription for example”.
Moreover, all these savings remain hypothetical, since they do not take into account the downside of such measures, namely a possible reduction in the use of medical devices or a renunciation of care, ” in the absence of recent work to simulate these effects “, justifies the report.
Long-term illnesses in the spotlight
The IGF also targeted long-term illnesses (ALD), responsible for 123 billion euros of health expenditure, or 60% of expenditure covered by health insurance, according to another report published yesterday evening. The latter are exempt from the remaining charge. Among the 29 diseases identifiedThese include people with diabetes, heart failure, Alzheimer’s disease, long-term psychiatric illnesses and a large number of cancers.
In total, 13.7 million people, or 20% of the population, were affected in 2021. A number that could rise to 16 million in 2030, the report estimates, for ” an increase in the net additional cost of the system of around 2 to 3 billion euros “The General Inspectorate of Public Finances notes that no changes to the ALD system have been made since 1986 and that the list of these illnesses has expanded over time.
“The system is poorly controlled by health insurance, in a context of scarce medical resources,” denounces the IGF – IGAS mission.
Public hospital finances have never been so degraded
The report proposes several measures to be implemented from 2025, including increasing the deductibles on patient transport, which would bring in between 90 and 123 million euros next year, or removing the exemption from the co-payment on certain procedures. For example, medicines with few medical services rendered, spa treatments or even the prescription of paracetamol would bring in around 150 million euros. A refocusing of the severity criteria on the most serious medical situations is also one of the avenues being considered.
These spending reviews come a few weeks before discussions on the Social Security Financing Bill (PLFSS) for 2025. The hospital federation has requested an increase in these finances, weighed down by inflation. The State is therefore looking for all means to scrape together money, elsewhere, while the “hole” for Health Insurance stood at 11.1 billion euros in 2023 and could remain at this level in 2024.
