Here is a report which should support the government in its desire to reform the reimbursement system of health costs. Despite the existence of financial aid to access a complementary health, many French waive this coverage due to lack of information. Worse, the complexity of the process is regular at the origin of their renunciation. According to the annual report of the Fund CMU (which manages the additional protection of the universal coverage of disease risk), they would be nearly 400,000 beneficiaries not to use the cheque given to them to subscribe to a mutual in the framework of aid to complementary health (ACS). This device is limited to people with income between 730 and 990 euros per month approximately, but too high to achieve universal health coverage complementary (CMU-C) has, however, been reviewed three years ago.
The check is however not negligible. The amount varies depending on the age of the beneficiary, 100 euros for under 16 years of age, 550 euros for more than 60 years. This financial aid “allows you to reduce, and in some cases to take over completely, the amount of the annual membership fee at a mutual”. “During the visits to the doctor, the ACS also allows to obtain a full exemption from advance payment of costs” and enables you to benefit, in some cases, “medical fees without excessive fee,” says the website of information dedicated to the ACS.
“A lack of information around this device,”
Since the reform of 2015, eleven organizations, including some hmos, are authorized to offer contracts of complementary health dedicated to the beneficiaries of this financial assistance. “If the ACS is essential in order to promote access to health care for lower-income households, it is clear that this device has not met with the desired success, regrets Patrick Ratta director of development at the national Union mutualiste interprofessionnelle (UNMI), even if the number of recipients has increased by 15% since the reform of July 2015.” Today, the ACS covers more than 1.6 million people and among them, 1.2 million are protected by a contract. But more people could benefit from it. “The rate of non-use is 60%. Which means that 6 out of 10 people who could benefit, don’t even make the approach,” says Patrick Ratta.
The reasons? “the lack of information, the complexity of the process, one still have to charge too much, the appetite for other contracts offered by the additional bodies” and not within the framework of the aid, details the development manager of the UNMI. For clarity, it is envisaged to merge the CSA with the CMU-C (complementary health free reserved for people who earn less than 730 euros monthly). Specifically, the draft budget 2019 to the social Security (PLFSS) plans to expand, starting in November 2019, the CMU-C eligible individuals in the ACS, to improve the reimbursement of their care and for contributions not exceeding 1 euro per day or 30 euros per month.
The bill that must be voted definitively on Monday, also provides for the establishment of the “remains at zero-load,” which provides full repayment by 2021 of some dental prostheses, or hearing aids and glasses, for the health Insurance and complementary. A measure that is already fear a rise in rates of mutual funds, making it even more useful the hints for the fund. To the extent that almost one French person in three has waived his right to treatment in the last 12 months, in half of the cases due to a rest load too high, according to a CSA survey published at the beginning of October.