The High Council for the Future of Health Insurance, in a forthcoming report, is considering the absorption of mutual insurance companies by the "Sécu". David Ollivier-Lannuzel and Gilles Girard, director of Thémis Conseil, our entity specialising in management consulting, organisation and IS transformation, believe that complementary organisations, "essential players", have a role to play in the overhaul of our social system.
By David Ollivier-Lannuzel
President of the Mutuelle civile de la défense (MCDef) and member of the HCAAM
and Gilles Girard,
Director of Thémis Conseil.
The complementary action, if it is no longer identified, disappears in plain sight.
The High Council for the Future of Health Insurance (HCAAM) is to publish a report on the changes to be expected in the French health system at a time when the government is considering reforming social security. One of the scenarios envisaged is that of a "grand Sécu", which could go as far as absorbing complementary health insurance. Some people are already talking about the spectre of a nationalisation of the French health system.
We are far from it, but it is clear that in recent years, under the guise of a frantic search for universalism, a series of new measures (ROC, 100% Health, ANI, contract for access to care) whose stated aim is to offer better social protection to everyone is pushing a little more towards the automation, or even the industrialisation of this protection. And one day the disappearance of complementary organisations?
Disempowerment of patients
Simplification is the right thing to do, but there is a real danger in removing responsibility from patients by erasing costs. For example, we no longer have a health care form and dematerialisation has helped to limit paper exchanges. All these actions, which simplify life, lead us to think and say that medicine is free.
However, the real costs are increasing, with repercussions on companies' social security charges... and on contributions, because mutuals have to balance their accounts. Automation is placing an increased financial burden on mutuals without anyone noticing.
Social protection is financed by deferred wages, but for the majority of French people, this is very difficult to understand: in their eyes, it is the health insurance system, and therefore the state, that covers, with everyone being protected for the same price. If the complementary action is no longer identified, it disappears from view.
At a time when the HCAAM is redefining the role of complementary organisations, it is time for mutualist players to react and reinvent the services they can offer their members.
In particular, they must think about the process before and after care. Setting up reception areas for families is going to become a major challenge and it is a race in which mutual insurance companies must engage... by finding their economic model. Because their limited number of members is likely to deprive them of the obvious effects of scale from which compulsory health insurance benefits.
Specificity of mutuals
Faced with the immense challenges - financial, social and health - facing social protection, the only possible choice is to work together to build a new universal and viable model.
Alongside the health insurance system and the State, complementary organisations are more than ever an essential player in the health care system. Redefining the responsibilities of each is becoming a crucial issue to guarantee the survival, or rather the rebirth, of our social system and the cohesion of our society.
