[LUM#6] Healing at Any Cost?
The surge in chronic diseases, the redefinition of healthcare practices, the digital revolution… As we enter the 21st century, our health insurance model appears to have reached a crossroads.
Between 1970 and 2012, the share of GDP allocated to health care 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 the economic evaluation of health, immediately debunks a persistent cliché—the “old-age crisis”: “Population aging is only a marginal factor because people are aging in increasingly good health.” The reasons lie elsewhere: rising costs in the medical sector, technological innovations made accessible to all, improved screening policies…
Social justice
Healthcare isn’t just a cost, after all.“A good healthcare system benefits the economy: good health increases labor productivity and has an indirect effect on savings—and thus on investment,” notes the associate professor at the Faculty of Economics. “The real question, then, is: who pays for it, and based on what collective decision?”
As part of the welfare state, established in 1945 out of a “basic concern for social justice,” health insurance is funded through a collective effort based on social security contributions. This social contract has been undermined by the growing perception among citizens that they are spending more and more for less and less coverage. A key factor is the increase in long-term illnesses (ALD), which are covered at 100%, a trend that has automatically reduced the reimbursement rate for the rest of the population.
Toward the individualization of risks?
“A healthy 35-year-old man has no reason to benefit from such a system today,” the researcher summarizes . Faced with this new reality, the temptation for a historic shift is emerging: could the future lie in the individualization of risks, based on a “bonus-malus” model where everyone pays what they owe based on their behavior? A prospect made all the more plausible by the arrival of connected devices that facilitate personalized monitoring. For Valérie Clément, we’re not there yet: “The French are very attached to the principle of socializing health insurance costs. It’s also worth noting that public funding is very effective.” The effectiveness of private funding, meanwhile, remains to be proven. This is illustrated by the example of the United States, the world leader in per capita healthcare spending, yet with results that are widely criticized.
A necessary shift in practices
What is the solution for keeping health insurance costs under control? “Healthcare delivery must be more collaborative, multidisciplinary, and coordinated,” the expert asserts. In fact, the consolidation of healthcare providers into health centers is already a reality.
Another approach: to include in the economic evaluation a range of non-pharmacological interventions that have not yet received much attention (see Alternative Care ). These include prevention and the promotion of best practices, which have a very tangible impact on healthcare spending. This touches on the individual responsibility of each person, in a country that still consumes 40% more medications than Spain, for example, favoring newer and more expensive drugs over generics.
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