https://www.latribune.fr/opinions/tribunes/debloquons-notre-systeme-de-soins-par-le-libre-choix-d-un-assureur-683830.html
Let's unblock our healthcare system by the free choice of an insurer
The unblocking of our healthcare system is at hand, through competition, like other countries in Europe.
By Guy-André Pelouze, MD, Cardiovascular & Thoracic Surgeon
"Out of breath" is the leitmotiv of care actors. But the system is not in escheat. The state and its health insurance monopoly are more powerful than ever. The two decision-makers have large financial resources at 12% of GDP. But what does not work? What is the diagnosis?
From the scissors effect between the scarcity of the medical supply and the infinite free demand, from galloping bureaucratisation to digital un-preparation, from the expenditure authorized by the state by a goal rarely respected in the deficit, we understand the contradictions that affect the efficiency of our health care system. Two central questions arise.
Who is behind the structural changes that led to this chaos? Who is the sole actor of this system adrift?
Egalitarian Manicheism
It is easy to answer the first question but it is a taboo that forbids us to think. All these decisions are made by successive governments and their administration. An emblematic example of the number of students admitted to medicine; not only since the 1971 year of the first numerus clausus the state has never doubted but one continues to believe it, persevere diabolicum. Does this mean that our officials are bad? Of course not, not any more than those from across the Rhine or from beyond Leman. But that is too much embrace embraces. The French state wants to decide everything from Paris in an egalitarian Manicheism that loses it and destroys the fabric of care. The treatment is simple: a smarter state. The care system is in a way exceptional but it relates to the content of its mission and not to the exemption from the basic economic rules.
Auto-prescriptor Bureaucracy
The treatment of this over-regulation that feeds a self-writing bureaucracy of jobs is autonomy, massive deregulation and financial responsibility. There is a need for fewer administrative structures, fewer non-caring hospital jobs and a high level of management that starts with balanced accounts and tariff convergence. For ambulatory medicine, the contract is sufficient to regulate activities and demand. These contracts that the state will have framed by law but which will advantageously replace a single convention.
The answer to the second question is equally taboo. It is the administration of social security that false nose of the state called paritarianism without financial responsibility that is alone at the levers (262 billion in 2015). It must assume its responsibility in a triple failure to several billion: "vital" card reduced to a debit less bank card, an electronic medical record not shared because nonexistent and telemedicine reduced to videoconferences. The treatment, here too, is simple it is a certain amount of competition.
Security requires organizational innovation to converge existing resources and demand. According to his political inclination, one can resort to the competition of the "caisses" or to the opening of the health insurance to all the qualified actors because the innovation feeds on the differences. There is another benefit to competition, insurers in both cases will offer baskets of care. The insured will finally know what he pays and what is the content of the contract. He will have to insure himself for the major risk but he will be able to choose to save the part of the premium which reimburses the thermal cures, the transports, the daily allowances except for accident or serious illness, non-exhaustive list. Thus the decline in social security contributions will not be at the root of an increase in public debt but an increase in purchasing power. There will be clarification where there is collusion at the expense of the insured because of the complexity of the reimbursement rules and the inflation of premiums.
The electoral debates speak so little, while the release of our health care system is at hand like other countries in Europe.
Comments
Dr Guy-André Pelouze wrote on the 02/05/2017 at 10:05:
"Which system is advocated, that close to the US?" (Sic)
If you have read my article and if you know a little bit about the US care system you may not know that this is not the subject. On the other hand, it is curious at least that you answer yourself to this question by the USA whereas nothing allows advancing this answer. In reality, if you want at all costs to put simplifying labels (it is apparently your approach to complex issues) there are many countries in Europe where choosing an insurer is possible, one of the closest is Germany. The subject of this article is indeed the demonstration that choosing his insurer and the contract that goes with it allows adapting the offer to the demand. This is written in the paper: "the release of our healthcare system is at hand like other countries in Europe."
But back to France. For many French people, the health care system is blocked. This is the case in rural areas but also in urban areas at risk or in cities where the market price of renting business premises, a garage and a principal residence no longer allows for a financial balance. the practice of liberal medicine. In France, there is no longer any adaptation of supply and demand for care. This is very serious and the French are experiencing this decoupling while the situation will worsen in the coming years due to factors such as demographics (net entry of 200,000 people and decrease in the number of doctors); persistence of a numerus clausus, scarcity of liberal vocations; increase in the number of doctors in regulatory bodies; leakage of specialists because of the safety rates; net extension of the duration of studies.
Not to be aware of these shortcomings and to try to answer them by kicking in touch on the other side of the Atlantic shows an ideological bias that forbids thinking about the necessary changes. It has been a motivational goal for decades but today it is leading to disaster.
gfx wrote on 12/04/2017 at 18:51:
as it says Recoil below, health costs candy in the US "competition" system. the weight of health expenditure is the leading cause of bankruptcy of US households.
the Swiss "competition" system is also expensive. and France is ahead of Switzerland (and all other European countries) in seemingly effective care, according to the Eurostat study on avoidable deaths.
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Taking a step back written on 12/04/2017 at 17:52:
Which system is recommended, that close to the USA?
Small "accounting" details: do you know that Americans pay more for their health as a percentage of GDP (the USA is 17.1% in 2014 according to the World Bank)? Do you know that health care spending is lower as a percentage of GDP? The effectiveness of social security is much greater than that of private insurance (75% for Social Security and less than 50% for most insurances and mutuals). Indeed, not even very well managed (I concede), it saves advertising, sales, people who assess premiums case by case ... etc and of course the dividends.
It's not me who says it, it's official statistics (INSEE speaks)!
In fact this article responds to another economic problem: the calculation of GDP. If you give 1 euros to the security, it does not fit in the calculation of GDP, it is a "charge". If you give 1 euros to insurance, it is GDP and therefore "a wealth creation". Even if the insurance never heals you. And of course a capitalist system will always push the second solution because in this case a shareholder can put the euro in the pocket as a bonus or dividend. Ask yourself the question: who is the one who pays the one who wrote this article?
So if your logic is: "I want to pay less and have more care" do not be fooled. You would pay more if you were in the US (except for the better-off of us of course but nothing prevents them from going).
Public Health Response on 12/04/2017 at 22:25:
Completely agree with Take Back @. Social security costs 6% in management fees against 26% for complementary mutual or insurance companies, defended by the author of the article.
It is true that collective social insurance is included in the compulsory contributions while private social insurance does not enter.
In Germany, all incomes over 4000e / month can take private health insurance and thus not pay contributions in the public system. This explains a good part of the difference in the compulsory contributions between France and Germany. This one having 8 points less compulsory levies compared to France. But it is a statistical artifice, for those who contribute to private insurance, it is no longer compulsory levies but it is indeed compulsory expenditure.
This plea of the author of the article for private insurance is quite suspicious. This reminds me Fillon proposing in his program, the transfer of the care of current care of the sécu to the complementary (and thus partial privatization of security) and at the same time we learned that the main client of the consulting company 2F Fillon, was Axa! . All this feels the conflict of interest.
