15 billion euros: here is the figure in the form of a puzzle facing the government to reduce the public deficit from 4.9% of GDP to 4.4% in 2024. After four years of “whatever costs” caused by the Covid crisis and the energy crisis, the executive boasts a few weeks before the presentation of the finance bill the return to budgetary seriousness. With the key, therefore, around fifteen billion euros in savings to be found in state expenditure and that of social security bodies. Even if nothing is yet set in stone, among the tracks considered, we find the blow of a plane on housing aid with the abolition of the Pinel device or the reformatting of the RSA.
In health, a doubling of the medical deductible is also on the table. This is to touch the “residual charge”: in other words, the part that remains to be paid by the patient on the price of the box of drugs or on the price of the consultation. “The track being studied is to increase the current deductible by 50 cents, “while taking into account the most difficult situations” declared Friday, September 25 on the set of France 2, Thomas Cazenave, the new Minister of Accounts. public.
Introduced in 2008 by Nicolas Sarkozy, this deductible is 50 cents per box of medicines, 1 euro for the consultation and 2 euros for medical transport, with a ceiling of 50 euros per year and per person. Everyone is concerned except children under 18, pregnant women or beneficiaries of complementary health care or state medical aid.
For the government in search of fresh money, the doubling of the deductible seems like the dream martingale. The measure could bring back up to 1.5 billion euros or even more if the ceiling of 50 euros was raised… It must be said that this famous “rest at charge” – the RAC – is one of the lowest of the major developed countries. According to the latest statistics from the Ministry of Health, it barely reached 7% of all health expenditure in 2021, compared to almost 14% on average in our European neighbors with a peak of almost 20% in Spain. , 25% in Hungary, 27% in Portugal and up to 34% in Greece. Above all, it has continued to decline for the past ten years with the jump in the number of patients exempt from co-payments for long-term illnesses. The direct result of the aging of the population.
The fact remains that the doubling of the deductible is a purely budgetary measure which will have no impact on the over-consumption of certain drugs… health had nevertheless been advanced. A refrain sung again recently by Elisabeth Borne who declared at the microphone of France Bleu that it was a question of “making everyone responsible for a consumption of drugs which is higher than what can be seen elsewhere”.
A painless franchise
“Except that the generalized third-party payment has made this famous medical deductible invisible. The height of history, the deductible is even deducted a posteriori from the reimbursement of other medical expenses. A grotesque and incomprehensible system for the general public which, in the end, is very expensive for the community” denounces Frédéric Bizard, professor of Economics at ESCP and specialist in health issues. According to this economist, also president of the Health Institute, the co-existence of a dual system of reimbursement – by public social security and by private mutual insurance companies – entails administrative costs which approach 17 billion euros each year… a world record! “We must review the system of financing and reimbursement of health expenses from top to bottom. With the idea of a single funder for each type of care”, continues Frédéric Bizard. At the public safety, the most common and most expensive care. In private mutuals, the so-called “comfort” expenses. And here is the idea of the “Grande Sécu” once again mentioned by Emmanuel Macron during the last presidential campaign… An idea very quickly buried in the face of the barrage from the Mutuelles.