1/ What were the initial questions of your study about the impact of employer-mandated complementary health insurance on insurance coverage in France?

We sought to assess the expected impact of this scheme on two dimensions: first, on the reduction of the rate of persons without complementary health insurance (CHI) in France, and second, on inequalities of access to CHI, knowing that this generalisation excludes individuals outside the labor market, that is to say the most disadvantaged and sickest persons. Indeed, the rate of non-coverage which is estimated at 5% of the French population, according to data from the Health, Health care and Insurance Survey 2012 (ESPS), mainly concerns inactive, unemployed and the most precarious persons. We therefore studied the extent to which employer-mandated CHI would reduce or not inequalities regarding CHI coverage, and would improve access to CHI for those who want to be covered, without forcing those who don't.

2/ What are the assumptions and scenarios from which you simulate the expected effects of the National Interprofessional Agreement (ANI)?

Our work is based on a simulation of the insurance status that individuals of the sample will face (at 1 January 2016), given their characteristics observed in 2012. Specifically, we assume that all populations affected directly or indirectly by the National Interprofessional Agreement (NIA) - in terms of their current employment and family status - will have a complementary health insurance. We assume, however, that other individual characteristics such as income, health status and situation on the labor market remain unchanged. Three scenarios are considered. The first assesses the impact of the generalisation of employer-mandated complementary health insurance to all private sector employees on non-coverage in France. The second also considers the short-term unemployed, former employees and compensated, who can continue to benefit from the complementary health insurance of their former employer for up to one year. The third scenario includes the spouses and children of employees and unemployed people concerned with Ani. Indeed, although this scheme does not apply to them, most of the collective contracts are presently offered to them. To study how the generalization of complementary health insurance could even be questioned in the employed population, we also considered two assumptions related to waiver clauses: the first assumes that all persons employed under a fixed-term contract (CDD) of less than six months will refuse to adhere to the complementary health insurance established in the context of National Interprofessional Agreement, and the second considers that all employees with a temporary contract refuse to adhere.

3/ What are your key results?

Under the assumption of stable individual characteristics other than complementary health insurance, we show that the rate of people without CHI, estimated at 5% in 2012, increase to 4% after the generalization of employer-mandated complementary health insurance and to 3.7% taking into account portability, and provided that all persons concerned accept the proposed complementary. However, non-coverage would still be higher for the most vulnerable populations, that is to say, for the unemployed, the sickest and most precarious. Moreover, the rate of non-coverage might stand at 1.4% (versus 3.6% in 2012) among private sector employees if those with a temporary contract refused to adhere to this scheme. This measure, which should also reduce the link between non-coverage and preferences for time and risk, therefore risks to interfere on non-coverage by choice without eliminating non-coverage for financial reasons.

Interview by Anne Evans

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