Health insurance in France

The health insurance in France is one of the four branches of the Social security, and utilizes equal organizations (compounds for half of the representatives of the employers and employee) managing a public service, as for the employed persons the National bank of health insurance of the employed persons (CNAMTS), or the Social Mode of Independent (RSI) for the free lances (craftsmen, tradesmen, liberal professions).

Other private organizations (professional organizations, mutual insurance companies and insurances) can supplement the share taken of load by the health insurance.

History

At the origin reserved with paid and their family, the general scheme was gradually extended to other categories of the population (young people released of the Military service, divorced women not working, former prisoners, etc)

The ordinance S of the October 4th and 19th 1945 promulgated by the government of the Général de Gaulle create an organization of the Social security. These ordinances amalgamate all the old insurances and constitute a rupture with an old form of taking into account of social which dated from the pre-war period. They envisage the principle of a “management of the institutions of Social security by the interested parties”.

In 1947, the compensation for the industrial accidents, managed by private companies, is transferred to an autonomous branch from the Social security.

With the lengthening of the life expectancy, the development of medical progress and the improvement of the retirements, the Social security is confronted with financial problems soon. To face there, a ordinance of 1967 founds a separation in three autonomous branches: disease, family and old age. Each branch is then responsible for its resources and its expenditure.

The reform of 1996 implies a new chain of responsibilities between the actors for the social protection system: Government, Parliament, managers of the security systems social, professions of health and members of National Insurance Scheme.

Since January 1st 2000, the Couverture universal disease (CMU) allows any person with the scanty means residing in France to profit from the assumption of responsibility of its care (disease and maternity) whatever its activity.

The reform instituting a course of care coordinated (Law of August 13rd, 2004) restricted from now on these possibilities of complementary interventions.

The Health insurance within various modes

The social system of health insurance covers today almost all the population. This generalization of social protection is ensured by several modes.

The general scheme

The agricultural mode

It covers the agricultural owners and employees. It is managed by the central Case of the agricultural Social insurance system (MSA).

The social mode of the independent ones

It covers the craftsmen, tradesmen, industrialists and liberal professions, and is managed by various organizations, in particular the National bank of Health insurance of the independent professions.

Other “special” modes known as

mode of the sailors and registered sailors (ENIM);
mode of the Mines;
mode of the SNCF;
mode of the RATP;
mode of EDF-GDF;
mode of the Banque de France;
mode of the National Assembly;
mode of the Senate;
mode of the clerks and employees of notary;
mode of the ministers of religion;
etc

Financing of the health insurance

Finance bill of Social security (PLFSS)

The financing of the health insurance is ensured by the Finance bill of the Social security (PLFSS).

Deficit of the health insurance

In 2006, the deficit of the health insurance will rise to 6,1 billion euros. PLFSS adopted at the end of October 2006 by the deputies envisages to reduce the deficit to 3,9 billion euros in 2007.

Recovery package of the health insurance

For the first time since its creation in 2004, a recovery package of the Assurance-maladie was required on May 29th, 2007 by the the committee of alarm on the expenditure of health insurance. This committee must alert if the expenditure exceeds of 0,75% the national target voted each year by the Parliament within the framework of the Finance laws of the Social security (PLFSS). For 2007, the drift of the accounts is " about two billion euros" , euros of too compared to the 1,1 billion going beyond is 900 million which was authorized. This degradation is in particular related to the rise of 5% of refundings of care of city over the first four months of the year. Over the year 2007, this figure should be 3%, quite higher than + the 1,1% in annual rhythm on which the government counted.

It will comprise measurements of reinforcement of the Course of care around the attending physician. It will envisage to financially penalize the members of National Insurance Scheme who remain apart from this course, either that they do not have of attending physician, or that they do not pass by him to consult a specialist.

400 million economies aiming at the projected patients seraien, of which 100 to 200 million would come from the removal of the upper limit of the fixed prices of 1 euro on the consultations, the medical acts, the examinations and analyzes, currently limited to 50 euros per anybody of more than 18 years and per annum.

The Gouvernement Fillon must validate the recovery package of the health insurance before June 30th, 2007, the Comité of alert E having then fifteen days to deliver its opinion.

Long-term forecasts

The National bank of health insurance (CNAM) consider that the growth rate annual the twenty-five last years (1,3 point higher than the gross domestic product) should be maintained. The Dépenses of health insurance (Health expenditure) should reach 210 billion euros in 2015 against 140 billion in 2006 , that is to say a rise of 50% .

At the origin of this aggravation, the increase in the chronic diseases and polypathologies, should weigh very heavily. According to the CNAM, 73% of the Dépenses of care of city (1 000 euros per annum and by assured), in 2005, were concentrated out of 20% of the members of National Insurance Scheme, that is to say 7,4 million patients reached of one of the diseases recognized in Long-term illness (ALD) covered to 100% for the specific part of their treatment. In 2015, their number could reach 12 million. Among them, the victims of cancers are likely to pass from 1,4 million in 2005 to 2,6 million in 2015 and the diabetics of 1,3 million to 2,6 million. It should to it be added the increase in the prevalence of the cardiovascular diseases, of the chronic respiratory insufficiencies, the neurological diseases as well as the hoop nets related to the Vieillissement like the Maladie of Alzheimer. The growth of the related spending to the long-term illness (ALD) would represent more than 80% of the rise in the expenditure.

References

the government recalled to the order on the skid of the expenditure of the Health insurance , Le Monde, May 29th, 2007
the health expenditure could increase by 50% from here at 2015 , Le Monde, July 9th, 2007

Tools of contôle of the deficit of the Health insurance

tariff Rebates of the medical acts (news nomenclature of the technical acts)
Respect of the course of care

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