Dienstag, 16. Juni 2015

For a finally effective reform of the health insurance

For a finally effective reform of the health insurance
Need For a finally effective reform of the health insurance
How to reform health insurance in europe? This nagging debate rightly focuses on recurring deficits of Medicare. But another serious problem also exists in our health care system: in France, the state is often in conflict with itself in most areas of health care and health insurance. The state is both supply and demand, the insurer, the regulator, the prescriber and the health care provider, not to mention that it maintains a large confusion between the role of insurance and solidarity function; all with a weak and incomplete democratic transparency of health choices. In addition, land use considerations, local employment and industrial policy reinforce conflicts of interest and blur the incentives to provide better health at lower cost. Such a system does not work well, is expensive (France has the highest health spending in Europe), and more severe, it is likely to deteriorate in the future, unable to fund medical innovation.
I suggest here a reform that avoids conflicts of interest and provide the right incentives, all dominated and ruled by political choices strengthened in their democratic legitimacy. Health care providers should be only providers, insurers only insurers, the regulator only regulator with an explicit mission given by the legitimate political power. In addition, it would be desirable for democratic legitimacy reasons that insurance and solidarity functions are distinguished.
Closer to home, Switzerland, is a health insurance model that works at least as well as ours, but without the drawbacks of the French system. The Swiss spend their health 11.0% of GDP; in France, it is 11.6% of GDP. Swiss health indicators are among the best in the world. What would the implementation in France of a system to the Swiss?
Four principles. First principle, each resident would have the obligation to take out health insurance, paying directly. Second principle, each health insurance should accept any unconditional patient, regardless of age and health (principle of non-discrimination) and at the same price (possibly indexed on age premiums). Third principle, the state (government and Parliament) define annually the minimum basket of medical goods and services to be provided by health insurance, and a maximum price for each item. Fourth principle of solidarity: the State, after Parliament's vote, would fund health insurance for the poor, who can not afford health insurance.
The virtue of this system is that the health insurance can neither discriminate their customers or lower the level of mandatory coverage or increase their rates, can only act on two levels: they try to attract the maximum insured ( and must provide the best possible insurance) and they must control costs and effectiveness of healthcare providers (that France can not do). I will add a new democratic governance. Given the increasing complexity of health issues, I suggest that the Senate specializes in health issues (choice of objectives and definition of the basket of health goods and services to pay). The National Assembly vote overall funds dedicated to solidarity, but the Senate would bear the other public health choices.

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