The financing structure of social insurance coverage isn’t impartial or even has its personal value. Representation with medical health insurance, which mixes assets of financing, and produces inequalities.
This text was once revealed in cooperation with Mermoz, the magazine of the Circle of Economists whose factor 8 has the theme “Our social model, a masterpiece in danger”.
In spite of their variety, well being economists conform to deplore the present group of well being care financing. On the heart of the complaint is a French idiosyncrasy: the financing by way of two other actors of the similar basket of considerations. For instance, a session with a normal practitioner leads to repayment of 70% from social insurance coverage and 30% from supplementary medical health insurance (on the present price).
This structure is pricey and patchy. In a world comparability, France devotes a better a part of its well being spending to the prices of managing the gadget (Graph 1). The latter constitute 5% of overall spending in comparison to 4.3% in Germany, 1.8% in the UK and 1.7% in Italy. Most effective the US and Switzerland are doing worse. The principle explanation why for this situation is where occupied by way of supplementary medical health insurance. Despite the fact that they’re answerable for part of control prices, they quilt most effective 12.1% of well being spending.
It contributed with reference to 96 euros of maintain 100 euros
For an identical quantity, Social Safety funds just about 80% of well being care prices. Administrative charges for this are 4% in comparison to 19.4% on moderate for supplementary medical health insurance. For 100 euros of contributions, social insurance coverage supplies 96 euros of care and 80.6 euros of supplementary care. It’s conceivable to talk about the precise quantity, however the conclusion stays transparent. A public monopoly is especially economical, whilst the marketplace imposes many avoidable prices (contract control, advertising and marketing, and so forth.).
Determine 1: Expenditures for managing well being techniques in 2021
As a proportion of present shopper expenditure in world phrases
Writer supplied (no reuse)
Medical health insurance techniques controlled by way of public insurance coverage firms (left medical health insurance techniques controlled by way of personal insurance coverage firms (center) and nationwide well being techniques (proper).
Supply: DREES (2023, p. 180)
A trio of inequalities
Supplemental medical health insurance isn’t just pricey, but additionally unequal. The primary supply of inequality comes from the truth that no longer all of the inhabitants has supplementary medical health insurance. About 2.5 million folks don’t have supplementary medical health insurance, despite the fact that all have get admission to to social safety.
Every other supply of inequality considerations the differentiated stage of team spirit between social and complementary safety. Social Safety makes an enormous redistribution between source of revenue categories. Investment may be very revolutionary and get admission to to services and products is connected to well being standing. Against this, complementary employees display little team spirit and each and every source of revenue class returns its contribution.
A 3rd supply of inequality pertains to the range of complementary medical health insurance contracts: despite the fact that virtually all the inhabitants has complementary medical health insurance, no longer everybody has the similar. Then again, the most productive contracts have the richest, who’re additionally the least in poor health.
Huge social insurance coverage
Some of these criticisms (and plenty of others) lead quite a lot of economists to suggest an finish to complementarity. In a 2014 notice from the Council for Financial Research, Brigitte Dormont, Pierre-Yves Joffard and Jean Tirol beneficial “abolishing (the) mixed health insurance system”. A 2021 editorial revealed by way of Florence Jusot and Jerome Wittwer at the web site of the Faculty of Well being Economists hailed the “large social insurance” speculation. Those positions coming up from the middle of the self-discipline accept as true with the perspectives of the advocates of the political financial system solution to well being standing.
The e-newsletter of the Top Council’s record on the way forward for medical health insurance in 2021 supplied an extra laborious argument. For the primary time, an evaluate of the affect of the extension of social safety at the account of supplementary medical health insurance was once performed. The rise in necessary deductions could be greater than offset by way of the relief in contributions paid for supplementary medical health insurance. Financial savings are estimated at 5.4 billion euros in keeping with 12 months. Opposite to fashionable trust, public control would make it conceivable to succeed in vital financial savings whilst facilitating get admission to to care.
France 24 2022. Rediscovering the spirit of 1945
Then again, the venture to make bigger Social Safety leaves one query at nighttime: what limits must be positioned in this enlargement? Who must come to a decision at the related basket of care and eligible sufferers? Two primary choices are conceivable. At the one hand, it sort of feels herbal to consider that the federal government and the competent management proceed to manage social safety. Extending the investment would entire the nationalization of well being care investment in France.
However, this 12 months’s birthday celebration of the eightieth anniversary of Social Safety will also be taken critically. In 1945, this establishment was once an issue of socialization and no longer nationalization. To steer clear of pre-war social paternalism, social safety was once entrusted to people who elected their representatives from the native to the nationwide stage. This socialization must no longer be puzzled with control by way of unions and employers’ organizations. Within the first Social Safety election in 1947, any contributor is usually a candidate irrespective of whether or not he was once a union member or no longer. Then a type of twin energy between the state and social safety is established, a democratic pluralism that permits the habits of social coverage. If all this will likely appear contrived, it turns out to be useful to remember the fact that the native regime of Alsace-Lorraine nowadays in large part operates on those rules. The gadget is controlled by way of those that can come to a decision at the stage of investment for sure therapies or even at the contribution price. What if we reconnected with the spirit of 1945?
This text was once revealed in cooperation with Mermoz, the magazine of the Circle of Economists, whose theme in factor 8 is “Our social model, a masterpiece in danger”. You’ll be able to learn different contributions there.
The identify and intertitles are from The Dialog France.
