Nice Premium: Why are mutual insurance social contributions going to increase?
Thierry Pattou: For several years, mandatory health insurance has been stepping back. It has reduced reimbursements for medications, decreased reimbursement rates. Last year, there was the introduction of a 15% reimbursement rate for some medications. We learned that certain medications, which were reimbursed at 35%, with 65% covered by complementary insurance, will now be reimbursed at 30%, requiring 70% of the cost to be covered by the complementary health insurance. New taxes are also being levied on complementary health insurance, and unlike mandatory health insurance, mutuals cannot operate at a deficit. The social security system has been in deficit for more than 30 years. This is not possible for mutual organizations. They have an extremely simple budget management: income from membership contributions and outgoings for reimbursements to members, along with administrative fees which decrease with mutual mergers. Mutuals merge to reduce administrative costs. The accounting is very straightforward: income and expenses, and they are not allowed to be in deficit. When expenses increase, they have no choice but to increase income, hence the contributions.
NP: When will they begin to increase?
TP: Mutual firms operate on a democratic principle, and such decisions to increase contributions or decrease them on rare occasions, to increase reimbursements, or to create new reimbursements are made in general assembly, which usually takes place in June. So we will have to wait for the mutuals’ general assemblies in June 2011 to know, initially, if the social security financing law, as announced, has been adopted as it stands. Today, these are just announcements. The law has not been voted on. Decisions will be made collectively, democratically with representatives of insured persons and members, and these increases will likely take effect in January 2012.
NP: By how much will they increase?
TP: If the draft bill were adopted as it stands and became the social security financing law, with the new transfers of mandatory health insurance costs to complementary insurers as currently announced, including new taxes imposed on complementary health, contributions would probably increase by 5 to 10%.
NP: What does this mean for the mutual policyholder?
TP: Today, we are being told of another wave of non-reimbursable doctor visits or surgical procedures. Obviously, we hope not to have to increase contributions too much, but mutuals have no resources other than contributions. Therefore, if expenses rise, contributions will increase accordingly.
NP: How many people are affected by this increase in social contributions?
TP: In our country, one in two French people, about 36 million individuals, have chosen mutual health insurance to protect themselves. In recent years, other operators have entered this sector, notably insurers who previously only covered vehicles or property and personal damage. We now see banks offering complementary health products. I will stick to mentioning the number of mutualists, those who have chosen a true mutual, governed by the mutuality code, which is not the case for insurers or banks. There are 36 million of them.
NP: This measure originates from the government, are you contesting it?
TP: Of course, this is the 20th or 22nd time the government has proceeded in this manner, i.e., decreasing reimbursements, transferring them to complementary insurers, and it’s clear that it doesn’t serve any purpose since mandatory health insurance is still in deficit. This is not going to improve, since healthcare expenses, contrary to some claims, will not decrease. The population is aging, life expectancy is increasing, which is great, but we know that with increased life expectancy, healthcare costs go up, and new medical technologies are increasingly expensive. What the mutual movement calls for is a fundamental reform, a structural reform of mandatory health insurance. This system was established in 1945, immediately after World War II. There have been 20, 25, 30 patches, but today we need more than patches; we need a complete overhaul of the French health insurance system.
NP: Do you think these contributions will cause some people to forgo mutual insurance?
TP: That’s the risk we’re already witnessing today. With increasing complementary health contributions, they become unaffordable for some segments of the population who must make choices. The priorities are, of course, housing, food, and educating children. Unfortunately, some are forgoing complementary health insurance. A portion of the population benefits from free health coverage, the CMU (Universal Health Coverage), but those who do not qualify, because they are just above the threshold, may find it too expensive and may no longer afford complementary health insurance. This is a major risk, and today we already see people forgoing healthcare.
