Disease of long life

Definition

In France, one calls disease of long life one of the 30 diseases being reproduced on the list conceived by the French Health insurance . It gives place to full repayment of the care, after establishment of a therapeutic Protocole (Protocol of care).

The affections comprising a prolonged treatment and therapeutic particularly expensive are registered on the list of the 30 diseases drawn up with article D. 322-1 of the code of the social security.

They are named also Long-term illness (ALD 30).

List of the 30 affections

Cerebral vascular accident invalidating
medullary Aplasia
Artériopathie obliterating of the lower extremities chronic and evolutionary (including coronary) with ischemic clinical demonstrations
Bilharziose complicated
Cardiopathie congenital badly tolerated, serious Cardiac failure and serious Valvulopathie
Cirrhose of the liver décompensée
immunizing Déficit primitive engraves requiring a prolonged treatment and immunizing deficit serious asset (syndrome acquired immunodéficitaire)
or not insulino-dependant Diabète insulino-dependant which cannot be balanced by the only mode
serious Forme of a neuro-muscular affection (of which Myopathy)
Hémoglobinopathie homozygote
severe Hemophilia
arterial Hypertension
Myocardial infarction going back to less than six months
respiratory Insufficiency chronic low register
Leprosy
Parkinson's disease
metabolic Disease hereditary requiring a prolonged treatment specialized
Mucoviscidose
Nephropathy chronic low register and nephrotic Syndrome pure primitive
Paraplegia
knotty Periarteritis, érythémateux lupus acute disseminated, evolutionary Scleroderma generalized
Polyarthritis rhumatoïde evolutionary low register
Psychosis , serious disorder of the personality, mental backwardness
hemorrhagic Rectocolite and Maladie of evolutionary Crohn
Multiple sclerosis invalidating
evolutionary Scoliose structural (of which the angle is equal or higher than 25 degrees) until rachidian maturation
serious Spondylarthrite ankylosante
Suites of transplantation of body
Tuberculose activates
malignant Tumor, affection malignant of lymphatic or hematopoietic fabric

Interpretation

It is not enough to have one of the diseases listed to be entitled to the statute. Indeed, there are often criteria of gravity or date. For example, a myocardial infarction does not give right to the ALD that if it is gone back to less than 6 months. Beyond this time, it cannot open this right that if it gives place to a serious cardiac failure.

Other cases

The ALD can be granted in case:

of a serious affection, characterized, not being reproduced on this list, requiring one foreseeable duration continuous care higher than 6 months (affection except list)
several affections involving a pathological state invalidating, requiring one foreseeable duration continuous care higher than 6 months (polypathology)

- affections called “except list”; The affections of form evolutionary or invalidating, recognized by medical control, which are not registered on the list of the 30 diseases but which comprise one foreseeable duration a prolonged treatment higher than 6 months and therapeutic particularly expensive. - polypathologies.

The patient is reached several characterized affections involving a pathological state invalidating and requiring one foreseeable duration continuous care higher than 6 months.

CS, Article L. 322-3 and D. 322-1

Stakes, groups of the most frequent pathologies

The ALD constitute a stake growing on the human scales, medical and financial: nearly 8 million people is reached in France today one of these affections, the number of patients has progressed of more than 5% per annum for 10 years and the care exposed for this reason represents nearly 60% of the total of the expenditure refunded by the health insurance.

The three most frequent ALD in 2004 relate to approximately 4.2 assured million (64% of the 6,6 million ALD): cardiovascular affections (2 134.000,32%), malignant tumors (1 264.000,19%), diabetes of the type 1 and type 2 (1 211.000,18%). And 76% in very for the first 4 groups of pathologies, by taking account of the psychiatric affections of long life (896 000,14%).

Decisive importance of the prevention, to limit these diseases

It is established, by many studies, that the quality of the food preserves health, by decreasing considerably the risks of the majority of these diseases: cancers, cardiovascular diseases, diabetes, which alone represented in 1994 more than 67% of the number from the ALD and 57% of the expenditure.

The genetic factors and family, on which we have very little means of action, play finally a part definitely weaker than the quality of the food, the physical-activity, the consumption of alcohol and the nicotinism, on which it is possible to act, on the levels individual and collective.

It is to say the importance of the prevention, on these 4 fields:

diversified, with fruit and vegetables, and less salted food (salt is a considerable factor of hypertension in particular)
physical-activity
consumption of alcohol
active and passive nicotinism.

Whereas in France " more half of the patients who begin a anticholestérol treatment did not test as a preliminary a mode low in greases. However these drugs, taken with life, present risks of muscular attacks " , according to Reciprocity (see " Figures clés").

In these only 3 fields, the half of the deaths could be avoided (250 000 per annum!)

Cancers, cardiovascular diseases, diabetes, the half of the deaths could be avoided…

Either in France 250.000 per annum, or still 100 times more deaths than the fall of died on the roads since a few years…

38 billion euros of expenditure of care in France, from which the half could be avoided

Of course the financial stakes are not all. But they also make it possible to see how much diseases, of useless sufferings, nuisances in any kind could be avoided.

As well as deaths, of which the half could be avoided by simply changing patterns spending, food, of alcohol and tobacco….

As the ALD account for from now on 60% of the expenditure of the Health insurance, these diseases on which we have the means of acting, grace in particular to a food of quality, represent more than 34% of the expenditure refunded by the Health insurance.

This figure is already considerable: 38 billion euros (250 billion frans) per annum…

That is to say all at the same time: 5 times the annual deficit (2005) of Secu , 13% of the public revenue, the annual amount of the interests of the national debt, 60% of the budget of State education …

Pourtant this figure considerable of 38 billion euros does not hold account…

nor of the costs of the cardiovascular diseases and diabetes not dealt with at 100%: the number of people suffering from cardiovascular diseases in France is much higher than that which profit from the ALD, 2,134 million, since there are 3 times more hypertensive (7 million)
neither costs of other diseases on lequelles the food plays a great part, with the physical-activity and the excessive consumption of alcohol and the nicotinism (active or passive)
nor of not entered indirect costs, very high among which: stops disease, production loss, etc

In 2003, the cost of the sick leave rose to 7,4 billion euros, including 5,4 billion for the Health insurance. The proportion of these stops disease due to ALD is to be specified, but it is extremely probable which the associated costs with the ALD are at least 50%, that is to say 2,7 billion for the Health insurance.

The production loss for France, and of pure GDP France, must be even more important.

Long-term illness (ALD) and medical frankness

The increasingly high cost of the ALD is in the middle of the controversy caused by the creation of medical Franchises, whose estimated resource would be without common measurement with the increase in the expenditure. The proposal made by Martin Hirsch, High commissioner with active solidarity against poverty, in favor of a " medical Shield " bound to the returned of households supposes a radical transformation of the catch into load of the ALD.

See too

External bonds

stakes of the prevention: (much) more than 40 billion euros per annum

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