Since the end of 2017, health professionals, device manufacturers, complementary healthcare insurers and the government have been engaged in consultations to implement one of the campaign promises made by the President of the Republic i.e. to achieve 100% cover for glasses, as well as hearing aids and dentures. All players in the different sectors have been meeting for negotiations that can only be bitter and complex because, if patients are to get the gift of zero co-pay then financing this will require everyone to make an effort. In this zero-sum game, the winners could be the losers and vice versa.

The principle is based on a “zero co-pay” basket of covers

Even if some people look strangely surprised, the promise of 100% cover for optical expenses, hearing aids and dentures will not cover all treatment received by patients. If this were the case it would cost over EUR 3bn and would clearly have inflationary effects. The negotiators are moving towards designing a basket of covers for which patients would have nothing to pay. Such a scheme means drawing up a list of basic benefits that meet what are considered to be fundamental needs. Obviously, if glasses, hearing aids and dentures are to be refunded 100% by a combination of first and second tier healthcare insurances, premium rates will be regulated. Negotiations are thus centred around the issue of agreeing on what parameters to establish. To what extent will covers and rating remain uncontrolled? What level will rates be set at? What counterparties will there be to these new covers?

Glasses and hearing aids are still sticking points

The negotiations on dentures are nearing completion. The capping of pricing for dentures has been accepted by dentists in exchange for a revaluation of dental restoration techniques. Currently, the government and representatives of the profession are discussing what treatments will be contained in the “zero co-pay” basket of covers and which will be subject to free or controlled pricing. More than half of all dentures may well be obtainable by patients with no co-pay. This is a real breakthrough.

Negotiations are making no progress in the areas of optical and hearing aids. This is understandable because price controls would undermine the business model of these two industries. For example, hearing aid specialists do not want to distinguish between providing devices and on-going patient monitoring. Currently, the cost of maintaining and adjusting devices throughout their useful life is built in to the sales price of the device. This would all change. The same discontent can be found among opticians who feel aggrieved. Firstly because price controls would reduce their margins. What is more, certain of the counterparties put forward, such as refunding glasses every three years instead of two, would create a real risk of cutting back on opticians’ business activity. At this stage of the negotiations, the two positions seem unreconcilable. The system of practitioner networks, however, had indeed shown that it was possible to guarantee 100% optical cover for a large majority of needs.  

The numbers are straightforward for second tier insurers

Complementary healthcare insurers had been singled out for criticism during the presidential campaign. Now that the preposterous idea of a hidden pot of money that could finance better cover for patients has been swept aside, these insurers are back to their role as guarantors of a balanced healthcare system. If cover is increased then premiums will go up.  This would be tantamount to making insureds pay for the cost of “zero co-pay” whilst at the same time they are the patients. Even so, the health minister (Minister for Solidarity and Health) has assured that contributions will not change. Complementary healthcare insurers are waiting for the end of the negotiations before doing their sums. It is quite obvious that if some covers are increased and contributions do not change, then other covers will be cut back. The first-tier healthcare system is currently running a deficit of 4bn Euros and could not finance “zero co-pay” any other way.

Will the customer be the real winner?

At the end of the negotiations, the “zero co-pay” basket of covers could turn out to be a real breakthrough in meeting patients’ needs. According to the first-tier healthcare scheme, almost 40% of people who would require dentures do not seek treatment mainly because of the cost. We can only applaud the government’s decision to bring together all sectors to imagine solutions which are proving to be based on how the practitioner networks function. Care should be taken, nevertheless, not to create a regulatory paraphernalia. Multiplying constraints, cutting back freedom of choice, making treatment classifications and premium rating more complicated would, in the end, make it more difficult for insureds to understand cover and make claims. Any reform which does not lead to greater clarity for insureds would be a reform doomed to failure

.Damien Vieillard-Baron.