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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).