Monday, September 24, 2007

Financing la Sécu


The government presented its proposal today for decreasing the social security deficit: 50-cent co-pays on prescriptions and "paramedical" services, 2 euro copay on medical transport. Figures low enough to make Americans green with envy, even if some French will groan in misery. Plus a tax on dividends paid by firms to stockholders.

Still, the expected reduction amounts to only one-third of the deficit, about 4 billion euros (can that be right? How many prescriptions are written annually in France? Anybody know offhand? TO ANSWER MY own question: in 2003, nearly 1.9 billion prescriptions were reimbursed by la Sécu. That's an astounding number! More than 30 scrips for every man, woman, and child in France, which is known to be the heaviest drug-consumer in Europe.)

As for the tax on dividends--hardly a "neo-liberal" measure, that. There will also be new taxes on early retirement and forced retirement, to be paid by firms. There, the supply-side logic is clearer: extending the working life is one of the government's structural reform goals. Of course, to the extent the strategy succeeds, the expected tax receipts decline.

9 comments:

Anonymous said...

Now that's not really correct. If you don't have a mutuelle, in addition to state health insurance, your copay is anywhere from 30-65% (though people with long-term illnesses have no copay for most things).

This said, when some meds cost 1 or 2 euros, paying 50 cents per box is problematic.

Unknown said...

Anonymous,
Why is it problematic? Whatever your original copay, we're talking about an increment. If a patient can now afford x, is x + 50 cents going to deprive anyone of medication? For how many people would such an increment pose a real hardship?

I couldn't find a figure for the number of prescriptions issued in France, but in 2005 the cost of reimbursement amounted to 8.7 billion euros. That, too, is a cost imposed on taxpayers, as is the cost of servicing the debt for the ss deficit.

Anonymous said...

It'll be problematic for the million + people who are on the RMI, and for many others with low income.

Unknown said...

Anonymous, the total annual copay is capped at 50 euros, and recipients of the RMI are excluded, as I understand the bill. Am I wrong about that?

Unknown said...

Here's the statement on exemptions:

les franchises médicales ne s’appliqueront pas sur les bénéficiaires de la couverture maladie universelle (CMU), c'est-à-dire les personnes les plus pauvres, les enfants mineurs et les femmes enceintes, soit au total 15 millions de personnes, selon les évaluations de la ministre de la Santé.
http://www.lefigaro.fr/assurance/20070924.WWW000000513_securite_sociale_les_franchises_medicales_ne_fait_pas_lunanimite.html

Anonymous said...

Thank you for clearing that up. Even on the news this morning (on LCI) they didn't mention that. As for the annual cap, I haven't heard anything about that. If there's a cap, I wonder what the point of the measure is?

In the latest Que Choisir (the French Consumer Reports) there's an article about medications being reimbursed or losing their reimbursable status, pointing out that doctors are prescribing newer, often less efficient medications rather than more established ones, and that that is increasing the cost of health care.

But no matter how you slice it, the cost of medication is a minor share of the total; it's just the most visible part to users. They always focus on meds rather than on hospital costs, or, for example, on paramedical costs that are sometimes excessive.

Anonymous said...

Just to come back to finding the numbers. A site which gives alot of facts is www.quid.fr and the chapter on medical acts (http://www.quid.fr/2007/Sante/Medecins/1) gives the 2003 numbers. Taking the numbers you cite, Art, of 1.9 billion prescriptions that would seem to average out to over 3 reimbursed items per medical act (if I have not miscalculated). I have no idea how this compares to other countries....

Unknown said...

kjs,
Thanks for the reference. I believe that 3 prescriptions per visit is about right. See also the later post on "The Slippery Slope Argument" for further details on French med use.

Anonymous said...

^^ nice blog!! ^@^

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