Healthcare professionals networks enable patients to get cheaper treatment and obtain better reimbursement from their complementary health insurer (mutuelle) for optical and hearing-aid items. This has been borne out by a report published in September 2017 by IGAS, the French government’s consultative body on societal issues. This is a serious and comprehensive report that also brings out some shortcomings, weaknesses and areas to keep under surveillance: a simplified legal framework, no real impact on curing “medical deserts”, restricts the freedom to choose one’s healthcare practitioner, etc. Subtle conclusions that are ammunition in the ongoing opposition waged by healthcare network detractors. Why so much ill-feeling?
Healthcare networks are about to take off!
Healthcare networks bring together healthcare professionals offering a certain number of services at negotiated rates for people insured with specific insurers. These types of schemes are mainly for optical, hearing-aid and dental items, which are healthcare areas where the level of Social Security reimbursements is much lower than the prices charged by practitioners.
Healthcare professionals networks (Santéclair, Itélis and Carte blanche, etc.) have shown spectacular growth over the last ten years. In 2016, they took a third of the market for optical items (up 11% in one year) and 20% of the hearing-aid market. Today, more than 45 million people in France potentially have access. Since 2014, complementary health insurers are allowed to encourage their insureds to give priority to healthcare practitioners who are network partners. How? They do this by increasing the level of reimbursement when the services are provided by a practitioner who is a network member.
Here is why they are angry.
Healthcare networks offer practitioners a different deal: more customers in return for lower prices. Now that thousands of health professionals have taken the plunge, the unions are alarmed at the rising influence of healthcare networks. The networks put pressure on to reduce prices and reduce practitioners’ freedom by imposing a series of extra constraints and controls. Healthcare professional representatives are afraid that the imbalance against them in contract negotiation will continue to grow. This is without taking into account the fact that these networks are not subject to the same ethical and publicity rules as the practitioners themselves. But do they really deserve to be accused of leading to lower standards of care and inevitably to “two-speed” medicine? Certainly not!
Real gains for insureds.
These healthcare networks are clear evidence of the ability of complementary health insurers to regulate the sector. The Social Security objective of keeping down fees and reducing copays, which has not been successfully achieved with the Optam scheme, is also an objective shared by the healthcare networks. One must admit that the objective has been achieved in the optical sector. IGAS, in its report, says it found a difference of -20% on adult lens between the rates charged within the networks and outside the networks. The difference for frames and hearing-aids is more like -10 %.
Fact-checking by Gerep out in the field.
Gerep conducted its investigation in a well-known outlet, member of several healthcare networks. For the same pair of glasses, the rates charged to members of the Itélis network represented a saving of 22 %. The reduction even went as far as 25% for members of the Santéclair network, i.e. a saving of €90 on a device costing €359. This is before taking into account the impact of differentiated refund levels practised by some complementary health insurers. IGAS states, the aggregate effect is that insureds using the networks for their optical needs, are left with a copay that is 50% below what it would otherwise be. In the light of these figures it is difficult not to admit that this is a system – albeit imperfect – that has a rare particularity, that of facilitating access to healthcare without costing the taxpayer a single penny.