Web-economic-crisis-health-systems-and-health-web
Web-economic-crisis-health-systems-and-health-web Web-economic-crisis-health-systems-and-health-web
Chapter 3 | The impact of the crisis on the health system and health in France 83 Fig. 3.3 Percentage of total expenditure on health according to source of revenue in France, in 2007 and 2011 2007 OOP payments 7% VHI 13% Other 1% 2011 OOP payments 8% VHI 14% Other 0% General government 5% SHI 74% General government 5% SHI 73% Note: Data rounded to the closest whole number. Source: OECD, 2013. 3.2 Changes to coverage Population coverage (entitlement) There were only minor changes in entitlement for coverage in a population benefiting from 99% SHI coverage prior to the crisis (Chevreul et al., 2010). In 2009, the minimum subsistence income (le revenu minimum d'insertion) was replaced by the active solidarity income (revenu de solidarité active) to provide income support to the working poor while enhancing incentives to work. This increased the overall number of recipients of this benefit and the population entitled to free coverage since the beneficiaries of the new active solidarity income automatically has the right to benefit from the statutory universal health coverage (couverture maladie universelle; CMU) and VHI (CMU-C). In addition, the income threshold giving access to the health insurance voucher plan (aide pour une complémentaire santé; ACS) was lifted from 20% above the CMU ceiling to 30% in 2011 and to 35% in 2012, and the state defined minimum criteria for ACS vouchers delivered by VHI in 2012. Finally, measures to increase coverage of disadvantaged students and people over 60 via the ACS scheme were enacted in 2013. Benefits package From 31 March 2013, abortions (and related hospital costs) have been fully covered, leading to an estimated increase in overall expenses from €13.5 million to €31.7 million (LeMonde.fr, 2012). Likewise, contraception for girls aged 15–18 has been fully covered from the same date. 5 5 Décret No. 2013-248 du 25 mars 2013 relatif à la participation des assurés prévue à l'article L. 322-3 du code de la sécurité sociale pour les frais liés à une interruption volontaire de grossesse et à l'acquisition de contraceptifs par les mineures [Decree 2013-248 of 25 March 2013 on the participation of insured in fees linked to abortion and the acquisition of contraceptive drugs by minors].
84 Economic crisis, health systems and health in Europe: country experience Since 2003, some drugs with low therapeutic value have been delisted based on reviews using effectiveness criteria. In 2010, the coverage rate for drugs with weak relative medical benefit decreased from 35% to 15%, and in 2011, the rate for drugs with moderate medical benefit was reduced from 35% to 30%. An additional 26 drugs were delisted in 2011, including 17 that had been covered at 15%. User charges Overall, user charges for French patients have increased during the crisis (Fig. 3.3). In 2009, the penalty (co-insurance) for patients who do not follow an agreed medical pathway was increased from 40% to 70%. This should be understood in the context of the broader 2004 reform, which attempted to make patients more responsible for their consumption of care, including strong financial incentives for VHI not to cover the higher co-insurance and deductibles (applying for doctors' visits, some procedures and drugs). Moreover, in the context of the delisting of certain drugs described previously, co-insurance rates for certain less effective drugs increased from 65% to 70% in 2010. Likewise, the co-payment for inpatient stays increased from €16 to €18 per day. In addition, the co-insurance rates for medical devices increased from 35% to 40% in 2011. Finally, in 2012, the government abolished the €30 deductible for beneficiaries of state medical assistance for undocumented migrants (aide médicale de l’etat) introduced in 2011. There has been no specific response of the VHI sector to the crisis and the decrease in SHI coverage. As expected and observed already before the crisis, VHI demand and coverage increased, including also the CMU-C and ACS schemes, which are financed by the CMU Fund and operated by VHI firms (for the role of VHI, see also section 4.1). 3.3 Changes to health service planning, purchasing and delivery Prices and delivery of medical goods Under the 2013 Social Security Financing Law, lower prices for drugs and medical devices in both the ambulatory and hospital sectors are expected to result in savings of €1 billion, after price reductions have been repeatedly practised in previous years. This has been accompanied by incentives to control costs on the delivery side: in 2011, pharmacist remuneration was made partly independent of sales volume to encourage the dispensing of cheaper drug alternatives, which was complemented in 2012 by a pay-for-performance component rewarding the delivery of generic drugs (Caisse nationale de l'assurance maladie des travailleurs salariés, 2013).
- Page 65 and 66: 32 Economic crisis, health systems
- Page 67 and 68: 34 Economic crisis, health systems
- Page 69 and 70: 36 Economic crisis, health systems
- Page 71 and 72: 38 Economic crisis, health systems
- Page 73 and 74: 40 Economic crisis, health systems
- Page 75 and 76: 42 Economic crisis, health systems
- Page 77 and 78: 44 Economic crisis, health systems
- Page 79 and 80: 46 Economic crisis, health systems
- Page 81 and 82: 48 Economic crisis, health systems
- Page 83 and 84: 50 Economic crisis, health systems
- Page 85 and 86: 52 Economic crisis, health systems
- Page 87 and 88: 54 Economic crisis, health systems
- Page 89 and 90: 56 Economic crisis, health systems
- Page 91 and 92: 58 Economic crisis, health systems
- Page 93 and 94: 60 Economic crisis, health systems
- Page 95 and 96: 62 Economic crisis, health systems
- Page 97 and 98: 64 Economic crisis, health systems
- Page 99 and 100: 66 Economic crisis, health systems
- Page 101 and 102: 68 Economic crisis, health systems
- Page 103 and 104: 70 Economic crisis, health systems
- Page 105 and 106: 72 Economic crisis, health systems
- Page 107 and 108: 74 Economic crisis, health systems
- Page 109 and 110: 76 Economic crisis, health systems
- Page 111 and 112: 78 Economic crisis, health systems
- Page 113 and 114: 80 Economic crisis, health systems
- Page 115: 82 Economic crisis, health systems
- Page 119 and 120: 86 Economic crisis, health systems
- Page 121 and 122: 88 Economic crisis, health systems
- Page 123 and 124: 90 Economic crisis, health systems
- Page 125 and 126: 92 Economic crisis, health systems
- Page 127 and 128: 94 Economic crisis, health systems
- Page 129 and 130: 96 Economic crisis, health systems
- Page 131 and 132: 98 Economic crisis, health systems
- Page 133 and 134: 100 Economic crisis, health systems
- Page 136 and 137: Chapter 4 The impact of the crisis
- Page 138 and 139: Chapter 4 | The impact of the crisi
- Page 140 and 141: Chapter 4 | The impact of the crisi
- Page 142 and 143: Chapter 4 | The impact of the crisi
- Page 144 and 145: Chapter 4 | The impact of the crisi
- Page 146 and 147: Chapter 4 | The impact of the crisi
- Page 148 and 149: Chapter 4 | The impact of the crisi
- Page 150 and 151: Chapter 4 | The impact of the crisi
- Page 152 and 153: Chapter 4 | The impact of the crisi
- Page 154 and 155: Chapter 4 | The impact of the crisi
- Page 156 and 157: Chapter 4 | The impact of the crisi
- Page 158 and 159: Chapter 4 | The impact of the crisi
- Page 160 and 161: Chapter 4 | The impact of the crisi
- Page 162 and 163: Chapter 4 | The impact of the crisi
- Page 164 and 165: Chapter 4 | The impact of the crisi
Chapter 3 | The impact of the <strong>crisis</strong> on the <strong>health</strong> system <strong>and</strong> <strong>health</strong> in France<br />
83<br />
Fig. 3.3 Percentage of total expenditure on <strong>health</strong> according to source of revenue in<br />
France, in 2007 <strong>and</strong> 2011<br />
2007<br />
OOP<br />
payments<br />
7%<br />
VHI<br />
13%<br />
Other<br />
1%<br />
2011<br />
OOP<br />
payments<br />
8%<br />
VHI<br />
14%<br />
Other<br />
0%<br />
General<br />
government<br />
5%<br />
SHI<br />
74%<br />
General<br />
government<br />
5%<br />
SHI<br />
73%<br />
Note: Data rounded to the closest whole number.<br />
Source: OECD, 2013.<br />
3.2 Changes to coverage<br />
Population coverage (entitlement)<br />
There were only minor changes in entitlement for coverage in a population<br />
benefiting from 99% SHI coverage prior to the <strong>crisis</strong> (Chevreul et al., 2010).<br />
In 2009, the minimum subsistence income (le revenu minimum d'insertion)<br />
was replaced by the active solidarity income (revenu de solidarité active) to<br />
provide income support to the working poor while enhancing incentives to<br />
work. This increased the overall number of recipients of this benefit <strong>and</strong> the<br />
population entitled to free coverage since the beneficiaries of the new active<br />
solidarity income automatically has the right to benefit from the statutory<br />
universal <strong>health</strong> coverage (couverture maladie universelle; CMU) <strong>and</strong> VHI<br />
(CMU-C). In addition, the income threshold giving access to the <strong>health</strong><br />
insurance voucher plan (aide pour une complémentaire santé; ACS) was lifted<br />
from 20% above the CMU ceiling to 30% in 2011 <strong>and</strong> to 35% in 2012, <strong>and</strong><br />
the state defined minimum criteria for ACS vouchers delivered by VHI in<br />
2012. Finally, measures to increase coverage of disadvantaged students <strong>and</strong><br />
people over 60 via the ACS scheme were enacted in 2013.<br />
Benefits package<br />
From 31 March 2013, abortions (<strong>and</strong> related hospital costs) have been<br />
fully covered, leading to an estimated increase in overall expenses from<br />
€13.5 million to €31.7 million (LeMonde.fr, 2012). Likewise, contraception<br />
for girls aged 15–18 has been fully covered from the same date. 5<br />
5 Décret No. 2013-248 du 25 mars 2013 relatif à la participation des assurés prévue à l'article L. 322-3 du code de<br />
la sécurité sociale pour les frais liés à une interruption volontaire de grossesse et à l'acquisition de contraceptifs par<br />
les mineures [Decree 2013-248 of 25 March 2013 on the participation of insured in fees linked to abortion <strong>and</strong> the<br />
acquisition of contraceptive drugs by minors].
Change language