The role of complementary health insurance organisations (Ocam) in the health system is contested by a growing number of players, as shown by the recent discussions on the work of the HCAAM. However, to ensure that it is solidified in the future, Gilles Girard, Director of Thémis Conseil, calls on the Ocam to accelerate on a subject that has not been mentioned much during this session: innovation.
"Recently, these two words have beenthe only ones on the lips of social protection players. And some of them - mutual insurance companies, health insurers and provident institutions - have not shied away from making a fuss about the scenario, mentioned in the work of the High Council on the Future of Health Insurance (HCAAM), which envisages an extension of the scope of intervention of Social Security to the detriment of complementary health insurance.
The most diverse, but all alarmist, figures have been brandished by the opponents of this scenario imagined as a possible response to the structural deficit of compulsory health insurance. But even if it has been officially abandoned by the Minister of Social Affairs, its shadow will continue to loom large, as the work of the HCAAM has no doubt already generated too much envy among the advocates of the Great Social Security for the machine to stop completely.
In this system, where only certain services would be paid for by the insured (excess fees, optical, dental, hearing aids, single room supplements in hospital), complementary health insurance would no longer seem so essential to many French people. A frightening prospect for these organisations. To defend their cause, opponents of the project explain that this system would be detrimental to the control of expenses and innovation. In the latter area, it is true that the future architecture does not offer the best guarantees and the work of the HCAAM never refers to this...
Let's be clear: this Greater Social Security system would not be the ideal vehicle for promoting innovation. It would certainly have the capacity to aggregate an unprecedented mass of data, at a time when data has become the tool for change and reinvention, the only one that can resolve the crucial issue of prevention by enabling the construction of a real health pathway. While we obviously need to stop its fragmentation and siloing, in order to better exploit its power, will the possible role of "single data collector" that the Health Insurance would have (with the State creating its own platform in which it would control everything, which everyone seems to think is normal) enable it to be a real driver of innovation? We would like to believe so.
When it comes to data, French social protection players have never been able to take the step of complementarity, even though this is the only way to work: mutual insurance companies must agree to share their data with the AMO and vice versa. Unfortunately, the levels of maturity are not the same, and the capacity of complementary organisations to collect data is still very unevenly distributed. Mutual insurance companies, in particular, have never been willing to really organise a tool for exploiting and sharing data for thirty years, despite an information master plan or their participation in the INDS. However, a potential platform exists, which is little known and under-exploited: the National Health Data System (SNDS) could play a real role... provided that it is developed and the flows, exchanges and control are organised. A vast undertaking.
However, these organisations need to think even more broadly about their innovation strategy, which alone would make it possible, by limiting risks, to combat health problems at source, where at present, thanks to digital technology in particular, it only serves to optimise processes. Covid, for example, has seen the explosion of teleconsultation and the creation of an unexpected super GAFA, the State. However, far from creating the conditions for innovation themselves, the three major complementary players within Unocam (CTIP, FFA, FNMF) - who are not even capable of sitting down at the table to draw up readable contracts - are striving above all to preserve their perimeters and their achievements, their standardised industrial systems.
Supplementary health insurance companies do not have the capacity to finance research and all too often, innovation is more reactive than intuitive. However, they must complement their role as insurers with a real role of accompaniment, because they play a definite role in creating a real axis of prevention, likely to encourage a reduction in health expenditure. Some have already taken action. The Vyv group, for example, is working on housing by signing agreements with professionals in the sector, based on the conviction that healthy housing can generate better health. Other groups have launched into health transport, accelerated outpatient hospitalisation and focused on home travel.
Much remains to be done in terms of health education, to make consumers of health goods more responsible. Major initiatives already underway, often at the initiative of the health insurance scheme, such as Sophia (for people with diabetes), Santé Active (coaching) and M'T Dents (dental care), show the way forward. It is up to the three major federations to seize this opportunity: in this area, health insurance will never be able to do everything on its own and will have to work in conjunction with complementary health insurance companies. What are they waiting for?
By Gilles Girard