The government's plan to transfer €1 billion of spending from social security to mutual insurance companies will widen inequalities in access to healthcare, warn experts and industry players.
In an attempt to reduce the growing social security deficit, the government plans to lower the health insurance reimbursement rate for consultations with doctors and midwives from 70% to 60%. It would be up to supplementary health insurance providers – or the patient themselves, if they do not have any – to cover the difference.
But this savings plan "is a decoy, costly and dangerous," quickly denounced the leading union of general practitioners, MG France.
Supplementary health insurance providers will pass on the new expense to their policyholders' contributions, leading to an "accelerated shift from a solidarity-based system (that of the Social Security) to a system where coverage is a function of contributions," the union criticizes.
The French will pay more, "without any improvement to the contract," protests the UFML-S doctors' union, also pointing out that the 2.5 million French people without supplementary health insurance will be "severely impacted," forced to pay out of their own pockets.
In fact, initial estimates by insurance experts show that the government's plan should lead to an increase in contributions of around 2% to 3%, depending on the assumptions used.
– “No redistributive effect” –
"A transfer of around one billion to supplementary health insurance would lead to an average increase of 2.8% in the benefits paid by these companies and therefore a similar increase in contributions," according to the specialist firm Addactis.
"But this assessment is an average: it masks higher increases in 'entry-level' contracts," for which the portion not reimbursed by Social Security weighs more, "or in senior populations, for whom the frequency of medical consultations is the highest," he warns.
The same diagnosis is made by Cyrille Chartier-Kastler, another insurance expert, who mentions an "impact" of "more or less 2.8%" for supplementary insurance expenses, which should be reflected in contributions.
The increase in contributions will be felt all the more harshly as supplementary health insurance has already implemented particularly strong increases in 2024 (+8.1% on average), highlighted by a recent senatorial report.
"To achieve a reduction in public spending, we choose to increase compulsory private spending" (such as contributions to supplementary health insurance), which are "more unequal" and "less effective," says economist Nicolas Da Silva, a lecturer and researcher at Paris 13 University. He points to "the management costs of supplementary health insurance, on average 19-20% compared to 4% for Social Security."
Unlike the latter, whose contributions increase according to income level, private supplementary insurance "has practically no redistributive effect", observe the statistical services of the social ministries (Drees) in a recent report.
– 33 to 146 euros per month –
Thus, the premiums paid to supplementary health insurance and the remaining costs after reimbursement represent 6% of the income of the poorest households (having a standard of living lower than 11,190 euros per year), compared to 3% for the most well-off, "despite aid schemes targeting vulnerable groups", such as the complementary health solidarity scheme (C2S), notes the Drees.
Supplementary insurance companies mainly set their prices based on age and level of coverage, with prices being higher for individual contracts than for collective (company) contracts.
For an individual contract, the monthly contribution varies from 33 euros on average at age 20 compared to 146 euros at age 85, for a "reference" insured, with varying levels of coverage, according to the same source.
With such a policy, the founding principle of social security, "everyone contributes according to their means, receives according to their needs", tends to crumble, with increasingly precise targeting of people who are fully reimbursed (chronically ill people, C2S beneficiaries, etc.), believes Nicolas Da Silva.
The economist points to a risk of "disintegration of the social pact": "a policy whose number of beneficiaries and quality are declining" could benefit from "less support" from the population.
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