Tribune. The “Grande Sécu” project would make it possible to advance equal access to care, that is to say full integration of all patients, regardless of their income condition and age, in the health care system. French healthcare system. The inequity induced by the coexistence of two support systems – compulsory health insurance (AMO) on the one hand, and complementary health insurance (AMC) on the other – have already been widely debated in recent weeks. .
The financing of the “great Secu” would benefit from savings in management and marketing costs, which represent around 20% of the premiums collected ; Making the State the guarantor of access to healthcare for all would be a further step in the rapprochement between Medicare and the State, which began in 2004.
Today, the debate centers on the role of complementary health insurance (AMC). The question is certainly important, but it distracts us from another question at least as important: do we have the capacity to have a sufficient supply of care to support this “great Safety”? With the “great Security”, private health insurance would indeed intervene only on care that is not covered by Social Security.
Impoverishment of the healthcare basket
Private health insurance, then called supplementary (AMS), would thus intervene in a market where there would be no State intervention. Access to healthcare would therefore be all the more egalitarian as the AMS market would be restricted. The size of the basket of care covered by public insurance would therefore determine the extent of equal access to care.
However, the current trend is towards the impoverishment of the basket of care. On the one hand, the network of hospitals is reduced, the number of beds is decreasing; on the other hand, there is a chronic shortage of doctors and medical personnel not only in health establishments, but also “in the city”.
This brings us to the issue of excess fees, as much in the hospital sector and clinics as for city medicine. It is a question of knowing what the “great Safety” would imply on the different types of tariffs which the practitioners can propose. Today, the AMO reimburses 70% of the base rate agreed.
The question of overruns
The remainder payable by the patient is 30% of the agreed base rate, to which is added the difference between the practitioner’s rate and this base rate. This remains transparent for a very large majority of French people, because this part is covered by their complementary. With the “great Sécu”, who will take charge of its overruns? Allowing the patient to bear the costs would introduce strong inequalities in access to care in a system that is nonetheless more egalitarian.
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“The” great Safety “project must not compartmentalize the difficulties of our health system”