3 questions to… Marc Perronnin, on the occasion of the publication of Issues in Health Economics (229), February 2018: Complementary Health Insurance in 2014: 5% Had no Cover and 12% of the Poorest 20% of Households Had no Cover, with the collaboration of Alexis Louvel
We wanted to offer an overview of the complementary health insurance cover before the generalisation of the employer-based complementary health insurance came into force. We relied on the data from the Health, Health Care and Insurance Survey (ESPS) 2014, which was published this year (Célant and Rochereau, 2017). The aim was to clearly identify the populations that benefit and those that do not, and to describe their profiles. We studied these populations in terms of socio-economic characteristics (income, age, employment, etc.), health status, and types of health coverage and contracts (when they had them). For example, beneficiaries of group contracts feel better reimbursed than those with individual contracts.
The long-term objective is to be able to study the effects of the generalisation of employer-based complementary health insurance before and after its implementation. Does it make it possible to reach populations without complementary coverage and thus reduce inequalities in access to this coverage? The next Employer-sponsored Complementary Health Insurance Survey (PSCE, Enquête Protection sociale complémentaire d’entreprise), will help answer some of these questions.
The rate of people declaring themselves without complementary health insurance is 5%. It has remained unchanged since 2008, despite the increase in the poverty rate over the period, but thanks to schemes such as Universal Complementary Health Insurance (CMU-C, Couverture maladie universelle complémentaire) or the Health Insurance Voucher Plan (ACS, l'Aide au paiement d'une complémentaire santé).
The absence of complementary health insurance is strongly linked to income: nearly 16% of unemployed people do not benefit from it, 12% of low-income people, 9% of housewives, 8% of people without a diploma and 7% of single-parent families. On the other hand, there are more people without cover among those perceived to be in poor health and among young adults between the ages of 20 and 29.
Among the working population, which is mainly covered, 3.3% of employees in the private sector do not benefit from any complementary health insurance. This is also the case for 5.5% of the self-employed and 1.4% of public sector employees. As regards employer-based complementary health insurance, the socio-professional categories least covered by this type of contract are, on the one hand, commercial employees (47%) and unskilled workers (49%) and, on the other hand, the youngest employees (40% of employees under 30 compared with 30% of 30-60 year-olds) and women (34% compared with 27% of men).
It can be assumed that, in the private sector, employees will be much more often covered by employer-based complementary health insurance after the generalisation of this coverage. Nevertheless, the extent of this increase and its impact on the coverage of beneficiaries will depend on the number of exemptions from membership and on the number of employer-based contracts that can be extended to relatives. For the beneficiaries of a group contract, there will always be better pricing conditions than for the beneficiaries of individual contracts.
The outcome is more uncertain concerning levels of cover, as it is conditional on employers, who did not offer cover, subscribe or not to reimbursements above the legal minimum. On the other hand, public sector employees, the self-employed and pensioners will not benefit from the extension of this cover, unless their spouse or other family member can make them benefit from it as an employee of the private sector.
Most of these populations are covered, but they more often report being poorly reimbursed for additional fees charged by specialists, for glasses and dental prostheses. The new specifications for responsible contracts, including the obligation to reimburse patients'contributions for almost all care and capping certain benefits, could help reduce this gap between individual and group contracts.
Interview by Anna Marek