Wednesday, June 25, 2008

Reform by Obfuscation

The government apparently wants to do something to control drug reimbursement costs, but exactly what it is proposing isn't clear. It seems that the cost of some drugs won't be reimbursed. Which drugs? Some say it's long-term medications for cancer and diabetes patients. Others say it's only "auxiliary drugs" used in the treatment of such diseases. Roselyne Bachelot, the minister of health, says that no decision has been taken but that she wants to maintain full coverage for chronic disease patients. But some of that coverage may be provided by private insurance rather than the state. Will private insurance costs go up as a result? Eric Woerth says no, but he also says he hasn't yet discussed the issue with private insurers. The unions are up in arms, concerned--understandably--about the rupture of "solidarity" with chronic patients, which would be a major change in the philosophy of French medical insurance.

So what is going on? Apparently an internal report on the reform leaked out before the government was ready, triggering an uproar and leaving the two ministers to cover the internal confusion with a temporary story. But the broad thrust of the proposal is clear enough: the government will stop covering some drugs, the costs will be transferred to private insurers, those without private insurance will continue to receive government coverage, and the private insurers--we are assured--will simply swallow the bitter pill. This is as incredible as it is nonsensical. It is reform by obfuscation, and even if the government somehow strong-arms insurers into accepting this plan for some period of time, obviously it will eventually result in increased premiums.


kirkmc said...

First, it's very clear that it's not the principal drugs for chronic illnesses; it's only those that are normally reimbursed at 35%. (That's usually "comfort" medication, or things that aren't considered to have high medical value.) But that could include drugs that help combat side-effects of principal drugs.

This said, one thing they're doing is limiting the number of "chronic" diseases, for which _everything_ is reimbursed at 100%: drugs, doctor's visits, transportation, tests, etc. For example, they want to remove hypertension from the list, which makes sense - while chronic, it is easily treated by medication.

This said, I was just discussing this with a taxi driver this morning: I have a chronic condition, and was being driven to an appointment. Rural taxis make most of their income from a) transporting people with chronic illness, and b) picking up stranded travelers who have travel insurance (or those who have car accidents, etc.) She was saying that in her experience, many people abuse this situation. But in my experience, there's not much you can abuse: your prescription has to clearly mention that any drugs you get are for your chronic condition, as do any other reimbursement forms.

In sum, it's murky, because they sent out a trial baloon rather than make an announcement. The complaints I've read (and heard on the news) get things wrong, just as you said ("some say" "others say").

But it should be said that French medical insurance is exemplary regarding chronic illnesses. I don't think this change will make a big difference either way; in any case, I'm not worried about it.


MYOS said...

To make things even clearer, last night on F2 Roselyne Bachelot said that her goal is to have all auxiliary drugs
This after using the third person "ça" to represent people with cancer.
Personally I like Philippe Seguin's idea to tax stocks at the same level as salaries much better. It seems that it'd right two wrongs at once: save the chronically-diseased extra suffering and taxing everyone the same.
( the projet means that a chemo patient who needs specific meds to keep food down would no longer be reimbursed 100% for those meds and would have to bear 2/3 of the cost himself/herself. Since many chronically-diseased or terminally-ill patients can"t work, many get very small amounts each month. If the 100% coverage goes, for most of them auxiliary meds go too.)

Just read Le Monde and found this- am still speechless:
le chef de l'Etat a souhaité que le futur président de France Télévisions soit "nommé par l'exécutif après avis conforme du Conseil supérieur de l'audiovisuel (CSA), et sous réserve qu'une majorité qualifiée de parlementaires n'y fasse pas obstacle". Actuellement, le président de France Télévisions est nommé par le CSA. La commission, elle, préconisait de transférer cette responsabilité au conseil d'administration de France Télévisions. "Partisan d'un système simple et démocratique", M. Sarkozy en a donc décidé autrement.

MYOS said...

Oosp.. came accross Le Monde while typing and, disbelieving what I was reading, forgot to finish what I was writing.
To make things even clearer, last night on F2 Roselyne Bachelot said that her goal is to have all auxiliary drugs 100% private-insurance covered.
A friend of mine said "well, since long and expensive illnesses aren"t likely to turn short and cheap, it means anyone ill will be looked on as a weight upon society. And if they can justify picking on cancer, MS, and AIDS patients, how will we be able to defend ourselves for an appendictomy or a broken arm?"

MYOS said...

I found plenty of info here:

kirkmc said...

Regardless of what finally happens, this situation points out a serious problem in France. There is such paranioia that whenever any reform is announced - especially when things aren't clear, which is the case here - the French go rampant with conspiracy theories, and you read and hear, in the media, tons of conflicting reports of what is going to happen. (The politicians - especially the "opposition" help fuel this fire.) It's like during the university reforms, the students were demonstrating because the state was going to "privatize" universities.

I think this kind of speculation is very dangerous. The articles I read saying that essential meds would no longer be reimbursed are just ludicrous - if you listened to what Bachelot said on TV the other night, she was adamant that it was only for 35% drugs. Also, this reform apparently has nothing to do with other medical acts for ALD patients.

So, while one can and should react, one should also be careful to not react about things that are not true.

MYOS said...

Hi Kirk,
the problem here is that what is considered "auxiliary" is indispensable to terminally-ill or disabled patients. While those drugs do not cure the illness, they facilitate treatment (or adverse effects of treatment.)
As for the 35% drugs being phased out of secu and transferred 100% to the private mutuelles, it is what Roselyne Bachelot said in a cumbersome way but Pujadas summarized it thus at the end of the news; but even if she hadn't: I have it from sure sources that it's in the works. A written document can even be found if looked for.

kirkmc said...

Yes, I understand that it's what they call "medicaments de confort". I happen to have an ALD myself...


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