The “100% Healthcare” reform was a promise made by Macron when a candidate in the 2017 presidential election. It became operative on 1 January 2019 and is already having an impact on the daily lives of employees undergoing dental treatment or looking for hearing aids.
This reform sets out to do away with co-payment amounts for dentures, glasses and hearing aids when part of government-defined “100% healthcare” “baskets”. Two or three device categories can be found in these “baskets”, as the case may be. Details are as below:
- Un panier 100% santé :
Laying down maximum retail prices (MRPs) for ophthalmic and hearing appliances, and maximum prices for dentistry,
• With revised, or non-revised base amounts for determining compulsory first pillar reimbursements [BRSS or Basis for Reimbursement by Social Security].
- Un ou deux autres paniers :
• A “basket” with charges at regulated prices,
• A “basket” with non-regulated (freely determined) prices,
• With reduced, or unchanged SS base amounts.
Gerep offers you, here, a summary of the reform at the end of the first “stage” on the way to full implementation in 2023. We have devoted this article to the visible effects of “100% Healthcare” in 2019. It takes a look at hearing-aid appliances (1 January) and dentistry (1 April) but also ophthalmics. Here are some explanations.
Hearing aid appliances
received especially as no updating had taken place over the last 20 years and the new list includes all currently-known devices. Some obsolete devices have been left out (such as devices with only 8 processing channels).
It is important to make a distinction between the sales price (maximum retail price = MRP) which is the maximum price a healthcare professional may charge an insured for the device and the SS reimbursement base amount (BRSS) which is the reference used by Social Security for calculating the reimbursement due on the device (in audiology, 60% x BRSS).
In practice, two classes of device have been created:
- -Class I devices: these make up the “100% healthcare” “basket”. These devices have 12 processing channels and an amplification system outputting external sounds at 30 dB. An insured benefits from a 30-day trial period before purchase and the device is guaranteed 4 years. Follow-up services are provided at least once a year to continuously adjust the device’s processing to changes in hearing loss.
- -Class II devices: contrary to the class I “basket”, the MRPs for this class are freely determinable. The base amounts used for reimbursement (by SS and second pillar mutual insurers) are, however, the same as in class I. There are more options (6) for class II devices compared to those in class I (at least 3)
| Until end 2018 | Depuis le 1er janvier 2019(1) | À partir du 1er janvier 2020(1) | À partir du 1er janvier 2021(1) | |
| Maximum price (MRP) for a class I device (100% healthcare) | No set price | 1 300 € maximum par appareil | 1 100 € maximum par appareil | 950 € maximum par appareil |
| Maximum price (MRP) for a class II device | No set price | No set price | No set price | No set price |
| Basis for Reimbursement by Social Security (BRSS) | 199,71 € par appareil |
€ 300 per device | € 350 per device | € 400 per device |
| Actual Social Security reimbursement (60% x BRSS) | € 119.83 per device | € 180 per device | € 210 per device | € 240 per device |
| (1) for people over 20. |
Dentistry
A new designation list will apply from 1 April 2019 following an agreement signed with the dentist federations. The objective is to reorient the work of dental practitioners towards more preventive, conservative dentistry.
The agreement fully complies with the spirit of the “100% Healthcare” reform as it sets out to reduce patient’s copay so as provide a response to the problem of people foregoing treatment (estimated to be 17% of the population).
Three types of dental treatment:
- Conservative treatment (scaling, treatment of tooth decay, root canal work, etc.)
- Surgery (extractions);
- nstalling fixed prosthetic devices (such as crowns, bridges, inlays, onlays and other appliances, etc.)
The first effects of the “100% Healthcare” reform can therefore be seen as of 1 April with the revised reimbursement base amounts for some conservative and surgical procedures. Set out below are the main increases in reimbursement base amounts on 1 April and the final values as of 2023.
As regards conservative and surgical procedures:
Again, it is important to distinguish between price (here, the fee) and the reimbursement base amount (BRSS). And so, as of 1 April 2019, the BRSS of only some procedures have been revised but not the prices charged (fees) as these are generally already regulated (except for inlays and onlays, for example, where fee overruns can be occur).
| Regulated charges (i.e. BRSS) | Until end March 2019 | From 1 April 2019 | Finally in 2023 |
| Finally in 202 | 79,53 € | 92,00 € | 100,00 € |
| 2-sided restoration | 33,74 € | 42,00 € | 50,00 € |
| Decay treatment, 3-sided or more | 40,97 € | 53,00 € | 65,50 € |
| 3-sided inlay or onlay | 40,97 € | 100,00 € | 100,00 € |
| Pulp capping | Not reimbursable | 60,00 € | 60,00 € |
| Root canal work on an incisor or canine | 33,74 € | 33,74 € | 47,00 € |
| Extraction of two milk teeth | 25,08 € | 30,00 € | 37,00 € |
Regarding dentures
Today, 1 in 6 insureds foregoes dental treatment, in particular when involving fitting dentures.
A maximum limit on crowns will apply from 1 April 2019, and this will be the first stage in pricing adjustments that will accompany those of routine procedures.
“100% Healthcare” will be implemented in two stages: in January 2020 for crowns and bridges (all types of material) and in January 2021 for fixed resin crowns.
|
Current average prices | From 1 April 2019 | Finally in 2023 | |
| Porcelain-fused-to-metal (PFM ) crowns (incisors, canines, 1st premolars) | 542,00 € | 530,00 € | 500,00 € | |
| Porcelain-fused-to-metal (PFM ) crowns (incisors, canines, 1st premolars) | Monolithic zirconia ceramic crowns (incisors, canines, premolars) | 480,00 € | 440,00 € | |
| PFM bridges | 1 575,00 € | 1 465,00 € | 1 465,00 € | |
| Removable full uni-maxillary resin dentures | 1 175,00 € | 1 100,00 € | 1 100,00 € | |
| Removable full bi-maxillary resin dentures | 2 192,00 € | No limit | 2 192,00 € | |
| PFM crowns (2nd premolars) | 542,00 € | No limit | 550,00 € |
Three “baskets” have been created along with this new designation list:
- – A “100% healthcare” “basket”
- – A minimised-copay “basket”
- – A freely-priced “basket”
These three “baskets” are devoted exclusively to prosthetic procedures. Each prosthetic procedure in the designation list appears in one of the 3 “baskets”.
The roadmap for the “100% Healthcare” reform covers the years 2019, 2020 and 2021 and affects dentistry, ophthalmology and audiology at various dates spread over the 3 years. Gerep will give you regular updates on the reform as it moves forward and any impact that it may have on corporate social insurances.