Benefits workshops

A BIG MESS FOR THE INTER-PROFESSIONAL NATIONAL AGREEMENT (ANI) AND RESPONSIBLE CONTRACTS

Posted on 19 November 2014

The spread in « supplementary healthcare » had all the hallmarks of being fantastic news, as much for employees as for employers.

The government has ruined everything, methodically and with determination.

Exactly one year has passed since the unfolding drama surrounding the designation clause, and now a new comically-tragic scene is being played out: the definition of the responsible contract.  If the aim was to lower optical prices and fees, then apparently it has been a total failure.

The decree issued this very evening has been put together without any assessment on its impact. It is merely an arbitrary gamble with the health of insured people!

A BIG MESS FOR THE INTER-PROFESSIONAL NATIONAL AGREEMENT (ANI) AND RESPONSIBLE CONTRACTS

An eruption in fees paid by the patient:

 

Management of excess medical fees is far too severe.  The asserted willingness to lower the price of consultations is completely unrealistic, as even practitioners criticise the health system fees as being too low and disproportionate to the hike in prices of their equipment as well as their accountability.

These practitioners are not their patients’ tutors and have no reason to lower their fees. According to an Ifop survey conducted for the consulting firm Jalma, waiting times to get an appointment are getting longer and longer for GPs and even more so for specialists (an average of 6 days for a GP and 111 days for an ophthalmologist) which only goes to exaggerate the situation even more.

The survey explains that this situation only goes to highlight the congestion in hospital emergencies, meaning skyrocketing prices for the Health Insurance System which, as a result, has to fork out several hundreds of Euros for a hospital admission as opposed to ten or so for a consultation in town; one may well wonder where is the saving in that?!  

The Moral of the Story: limiting the reimbursement of the excess in fees would end up with patients seeing a substantial increase in the fees for which they are liable. These could go up by a factor of 2.5 in certain geographical regions or for some specialist areas.

The Result: 100% of the excess being paid by the patient over and above the 46 € cost of a consultation with a specialist.

Those insurers and employers who refuse to play along with the farce of the responsible contract will be heavily penalised: as contracts which are labelled « not responsible » will be subject to a special Tax with an additional 5 points for insurance contracts; and especially because company schemes will therefore only benefit from social security exemptions made available for group contracts considered as responsible.

Less cover for more expense:

 

In order to retain a decent level of cover for their employees, some companies will be tempted to offer a basic core of responsible guarantees to which they would add extra supplementary options totally at the employee’s expense and without any social security exemptions being allowed.

So, employees run the risk of paying more for less cover. That is a weird take on defending buying power!

To save face, the government wants to extend the third-party payment system and discontinue the reimbursement of excesses for all insured people entitled to Universal Health Coverage (CMU) and Aid for Supplementary Health Insurance (ACS). For sure this is the best possible way to take away responsibility from the patients and encourage them to spend. This is already a betrayal of doctors who are calling for a strike during the last week of the year.

But, equally, it is a way of covering up the involvement of supplementary health care, for which the reimbursement would purely and simply be incorporated into that of the Social Security.  Supplementary insurance organisations would be blindly paying out, with no right to say anything about what they are reimbursing, and also become invisible payers, whereby their reimbursement – often more important than that of compulsory health insurance – would pass by unnoticed. Talk about being ungrateful…