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Medicare: treatment funded by income?

September 2 category:Economy
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Medicare: treatment funded by income?

Economists Pierre-Yves Geoffard and Gregory of Lagasnerie propose to cap the amount of expenditure remaining care annually to the care of patients, a ceiling fixed income.


This is not a reform, far from it. But certainly the revival of an old debate: reimbursement of care based on income patients. The government has, at this stage, no plans in this direction, but two economists Insee come to reopen the debate on the "health shield", the proposal supported by Nicolas Sarkozy and Martin Hirsch in the previous five years, quickly abandoned. .. Decryption.

A proposal Shock: pay care by income

Economists Pierre-Yves Geoffard and Gregory of Lagasnerie, both members of the Paris School of Economics, offer to cap the amount of expenditure remaining care each year to the management of patients. In other words, beyond a certain annual amount, all costs would be borne 100% by Medicare. This is what has been called in the past a "health shield" in reference to the "tax shield" of the previous government. This ceiling would vary by income insured more they are rich, the more it would be high, and therefore more expenditure remaining to be borne by patients, in absolute terms, significant. Example, in one of the scenarios studied, they could reach 2,087 euros per year for the 10% of insured with the highest incomes.

A measure justified by the "unfairness" of the current system

To justify their proposal, the two economists start from a simple observation: care expenditures now account for 8.2% of the budget of 10% of the poorest households, against 0.6% of the budget of 10% more rich. A perfectly unjust system, then. Another finding highlighted by these two experts: the most insured patients often find themselves with high load remains, despite the existence of "long-term affection" device which ought to allow them to be supported to 100%.

A costly reform, funded by franchises

For once, this project does not aim to reduce the social security deficit - recurring theme of all the reforms carried out so far. On the contrary, the idea of ​​two economists would be costly: to finance it, they intend to establish in parallel in parallel franchises. The first tens or hundreds of euros spent by the insured would not at all be reimbursed by Medicare - unlike the current situation where any expense incurred by a patient is reimbursed (for care outside hospital) to 65% on average. The amount of these deductibles also vary by income. Between franchises and ceiling, the current system would continue.

An upheaval that has little chance of the day

With this reform, the poorest patients, and those with the largest remaining to load, would be better covered than today. But the authors say themselves: this reform would many losers. Among the insured, they would be 80% see their annual spending increase over the current situation. Especially among young healthy assets whose annual expenses are low, and would have, because of the franchises, the feeling of not being reimbursed of all.

Supplementary insurance and mutual would also have much to lose. Policyholders have indeed improved visibility of costs they would have to pay out of pocket and could therefore be tempted not to purchase health-complementary. For the record, insurers and mutual fiercely opposed to the "health shield" ... fast garaged forgotten. Moreover, once the levees political opposition, it would technically at least two years, according to calculations made at the time by the promoters of the shield, to implement such a reform, because Medicare has aujourd ay no knowledge of income policyholders.

A reform that would not solve everything

The two economists are interested only expenditure for which compulsory insurance. This means that the proposal, if it were to materialize, would have no impact on the load-to-remains associated with excess fees, which are a powerful factor renunciation care and inequity between patients. Moreover, it is not certain that it would improve the management of optical and dental expenses. Finally, it would also leave aside the hospital remains to load, yet far from negligible in a number of cases

Other solutions exist

The issue of high load remains arises especially for the part of the population that does not have complementary health. Unemployed or retired, for example, does not have a care of part of their dues by employers as part of a collective agreement. They may therefore be tempted to move, unable to bear the cost. Beyond the CMU-C, reserved for the poor, another mechanism exists, though: "aid for the acquisition of complementary health" for people with low incomes, but above the threshold for entitlement to CMU-C. Today there are only about 620,000 beneficiaries for a target population of 2.2 million people. Better communication of government and social services in this regard would no doubt disseminate widely ...

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