While health issues are still struggling to emerge in the presidential debate, this could perhaps give the candidates food for thought. The High Council for the Future of Health Insurance (CAME) has indeed made public on January 17 its long-awaited report for the improvement of our health system. If one of these flagship proposals – the creation of a “Grande Sécu” which would eliminate complementary – seems for the moment not to have found an echo with the government, the report presents another unexpected proposal to contain the bill paid by households: the “health shield.”

“Schematically, this mechanism consists of capping the accumulation of remaining costs: from the moment this accumulation reaches a certain level or “ceiling”, health expenses are covered 100% by the Social Security. In this way, the maximum amount of cumulative out-of-pocket costs cannot exceed this ceiling, hence the term “health shield”, sums up the High Council, adding that the model has been adopted by many European countries. The first beneficiaries of such a measure would therefore be the most frequently ill French people, but also the most modest, especially if the ceiling is a function of income. Which is not yet decided.

Already debated in France, particularly in 2007, such an option would mechanically lead to an increase in reimbursements from health insurance. However, as conceded by the High Council, excess fees for health professionals would not be covered. “It would be risky, recognized one of the HCAAM experts during a press conference organized by the association of social information journalists (Ajis). This could have an inflationary effect on fee overruns.”

7.2 billion in expenditure for a ceiling of 400 euros

What would be the cost of such a measure for health insurance? The examples provided by the Department of Research, Studies, Evaluation and Statistics (Dress) are eloquent. Operated in 2017, these simulations bring to Social Security all the rest to be charged against in city medicine and in hospitals. This includes co-payments, flat-rate contributions and deductibles, but also the daily flat rate currently not covered by Social Security. The lower the ceiling, the more the measure is costly for the State, and the more the differences in the remaining dependents between the youngest and the oldest population are attenuated.

High council for the future of health insurance

By taking for example a ceiling of 400 euros for city medicine and the hospital, the additional cost for Social Security is estimated at 7.2 billion per year, but this ceiling would have the advantage of smoothing out the remainders to be paid for between the different patients. Patients aged 70 and over would pay “only” 2.5 times more money than the youngest. Conversely, a much higher ceiling, set at 1,400 euros, would be almost 4 times less costly for the State (2 billion euros) but would maintain an expenditure coefficient of 3.5 between the oldest and the young population.

It should be noted that if we exclude city medicine and only keep hospitals within the scope of this shield, the results would obviously be more disappointing for households. Moreover, this option is “not intended to profoundly modify the division of roles between health insurance and complementary health insurance, but only to avoid the existence of catastrophic dependent remainders”, warns the High Council.

High council for the future of health insurance

If a small proportion of households could ultimately benefit from this shield – 2.6% on average in the best case scenario – the proportions are much higher by zooming in on the targeted French people. Thus, 6.1% of people with long-term illness, 13.5% of French people over 80 and almost 7.5% of people in their 70s would benefit from such a reform. Better still: for seniors, this ceiling would lead to a reduction in complementary health contributions in due proportion, promises the HCAAM. The best scenario could reduce the contribution of over 80s by 225 euros on average, and 150 euros for those in their 70s.


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