[LUM#6] Healing at any cost?

[LUM Magazine] - Published on September 5, 2017 in Science-Society

An explosion in chronic diseases, a redefinition of healthcare practices, the digital revolution... At the dawn of the 21st century, our health insurance model seems to have reached a crossroads.

Between 1970 and 2012, the share of GDP devoted to health more than doubled, rising from 5% to nearly 12% of national wealth. How can this be explained? Valérie Clément, a researcher at the MRE and specialist in economic health assessment, immediately debunks a persistent cliché, that of the "old age peril": "The aging of the population is only a marginal factor because we are aging in increasingly good health." The reasons lie elsewhere: increased costs in the medical sector, technological innovations available to all, better screening policies, etc.

Social justice

Healthcare is not just a cost. "A good healthcare system benefits the economy: good health increases labor productivity and has an indirect effect on savings, and therefore on investment," emphasizes the senior lecturer at the Faculty of Economics. The real question is therefore: who finances it, and on the basis of what collective choice?

A component of the welfare state, established in 1945 out of a "basic concern for social justice," health insurance is financed through social security contributions, which represent a collective effort. This social pact has been undermined by the growing feeling among citizens that they are spending more and more for less and less coverage. Particularly at issue is the increase in long-term illnesses (ALD), which are covered 100%, automatically reducing the portion reimbursed to the rest of the population.

Towards the individualization of risks?

"A healthy 35-year-old man today has no interest in benefiting from such a system," summarizes the researcher. Faced with this new situation, the temptation for a historic break with the past is becoming apparent: could the future lie in the individualization of risks, based on a "bonus-malus" model where everyone pays according to their behavior? This prospect is made all the more plausible by the arrival of connected devices that facilitate personalized monitoring. For Valérie Clément, we are not there yet: "The French are very attached to the principle of socializing health insurance spending. It should also be noted that public funding is very effective." The effectiveness of private funding remains to be proven. This is illustrated by the example of the United States, the world leader in per capita health spending, with results that are widely criticized.

Necessary evolution of practices

What is the solution for controlling health insurance costs? "Healthcare provision must be more collaborative, multidisciplinary, and coordinated," says the specialist. The grouping of practitioners within healthcare centers is already a reality.

Another avenue: include in the economic evaluation a set of non-drug interventions that are still largely overlooked (read Alternative Care ). These include prevention and the promotion of good practices that have a very real impact on healthcare spending. This touches on the individual responsibility of each person in a country that still consumes 40% more drugs than Spain, for example, favoring new and expensive drugs over generics.

Keywords: Economy, LUM#6, LUM Magazine, Health, Company