Comments from France on the 2013 Commonwealth Fund Survey

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Presentation transcript:

Comments from France on the 2013 Commonwealth Fund Survey Pr Isabelle Durand-Zaleski

Key findings High population coverage by statutory health insurance Average: Spending Access Waiting times High complexity and costs of supplemental health insurance

The four paradoxes Every person is covered but not for 100% of their expenditures Single payer system for the statutory health insurance (SHI) but huge complexity for voluntary health insurance (VHI) Free choice of physician, but dissatisfaction with access Expensive for the payer but 2nd worst in financial access to care

Coverage Good for hospital care Medium for out of hospital with incentives to use gatekeeper and to use generics Very poor for eye and dental care

Complexity SHI: ensure that entitlement is recognized For means-tested government sponsored supplemental insurance, about 50% of the eligible population has registered For employer-sponsored or self paid VHI: complex, opaque (Le Monde survey) with hidden costs

Choice and dissatisfaction with the system Patients want to choose their physician, not their insurer (evidence from the government-sponsored program) Dissatisfaction with access: Télémédicine experiments

Expensive for the payer but 2nd worst in financial access Extra billing: 2013 agreement to limit extra billing to 150% of the official tariff eg 70€ for a specialist visit Direct third-party payment from SHI to physicians (resisted by physicians’ unions) Suggested reforms (not implemented): Out of pocket payments based on income Free hospital care

National strategy 2014 Increase generic use Reduce medication volume Control medication costs Fight against fraud and abuse