[LUM#6] Healing at all costs?
The explosion of chronic diseases, the redefinition of healthcare practices, the digital revolution... At the start of the 21st century, our health insurance model seems to have reached a crossroads.
Between 1970 and 2012, the share of GDP devoted to healthcare more than doubled, rising from 5% to almost 12% of national wealth. How can this be explained? Valérie Clément, a researcher at the MRE and a specialist in the economic evaluation of healthcare, is quick to dispel the age-old cliché of the "peril of old age" : "the aging of the population is only a marginal factor, as people are ageing more and more in good health". The reasons are to be found elsewhere: rising costs in the medical sector, technological innovations within everyone's reach, better screening policies...
Social justice
And health isn't just a cost. A good healthcare system benefits the economy: good health increases labour productivity and has an indirect effect on savings, and therefore on investment," stresses the senior lecturer at the Faculty of Economics. So the real question is: who finances it, based on what collective choice?
A component of the welfare state, established in 1945 out of a "basic concern for social justice", health cover is based on a collective effort to finance it, via social security contributions. This social pact is being undermined by a growing number of citizens who feel they are spending more and more for less and less coverage. Particularly at issue is the increase in the number of long-term illnesses (ALD), reimbursed at 100%, which has mechanically reduced the proportion reimbursed to the rest of the population.
Towards risk individualization?
"A 35-year-old man in good health today has no interest in benefiting from such a system," sums up the researcher. Faced with this new situation, the temptation of a historic break is taking shape: could the future lie in the individualization of risks, according to a "bonus-malus" model that would see everyone pay what they owe according to their behavior? A prospect made all the more plausible by the arrival of connected objects that facilitate personalized monitoring. For Valérie Clément, we're not there yet: "The French are very attached to the principle of socializing health insurance expenditure. It should also be emphasized that public financing is very efficient. The effectiveness of private financing, on the other hand, remains to be demonstrated. This is illustrated by the example of the United States, world champions in per capita healthcare spending, but with results that are decried.
The need to change practices
What's the solution to controlling health insurance costs? " Care provision needs to be more collaborative, multidisciplinary and coordinated," says the specialist. In fact, it's already a reality for practitioners to be grouped together in health centers.
Another approach would be to include in the economic evaluation a range of non-drug interventions that are still little considered (see Alternative care ). These include prevention and the promotion of good practices, which have a very tangible impact on healthcare expenditure. In a country that still consumes 40% more drugs than Spain, for example, and favors newer, more expensive drugs to the detriment of generics, we are touching on the individual responsibility of each and every one of us.
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