Mutuals knew that they would be called upon as part of the major oral prevention plan promised by the government. But not in the proportions made public, Thursday, June 15: the management of Social Security informed complementary health insurance that the coverage of dental care by Medicare would increase from 70 to 60% from October 1. Charge to mutuals, insurers and provident funds to compensate for this delisting, estimated at 500 million euros per year.
An effort confirmed and defended in the wake of the Ministry of Health, which presents it as a lever for financing a major plan for the development of oral prevention, the objective of which is to see the growth of a “first generation zero decay “. “The idea is that the savings generated [for Medicare, in the reimbursement component] can be quickly reinvested, with a transfer from curative to preventive”, justifies the ministry.
The complementary ones knew since the fall that they would be solicited. But the amount mentioned at the time, in the context of discussions on the 2023 Social Security financing bill, did not exceed 300 million euros annually.
“We regret the method”
Since then, discussions have been held with the Minister of Health, François Braun, his ministry and Social Security, in particular within the framework of the dialogue committee with complementary bodies (CDOC), launched in October 2022. Social Security finally decided, more severely than announced.
“We regret the method, with a unilateral decision, and the substance, with a short-term choice, purely accounting, and above all not likely to meet the health challenges of tomorrow, from medical deserts to the aging of the population”, breathes Eric Chenut, President of the National Federation of French Mutual Insurance (FNMF). The measure did not please the caregivers any more. In a press release published on June 16, Les Chirurgiens-Dentistes de France, the first trade union in the profession, sees it as only a “disengagement of the State”: “This unilateral decision suggests that oral health does not occupy not the same place as general health for the government. »
Neither “disengagement” nor “savings measure”, swears the entourage of Minister François Braun, who says he is guided only by a “need for joint efforts [in favor of oral prevention] between compulsory health insurance and complementary”.
“Inevitable” increase in dues
The Ministry of Health goes even further: the increase in the moderating ticket – the remainder borne by mutual insurance companies or the patient after reimbursement by Medicare – “does not generate additional costs for the insured”. More precisely, “the idea is that it does not translate into an increase in contributions, especially in a period marked by inflation. The government wants it and encourages it.” Mutuals, they doubt it.
Industry representatives do not see how the measure could not be passed on to patients. “It’s even inevitable, warns Eric Chenut, in the name of the financial sustainability of mutuals, quite simply. Some mutuals are barely balanced, others not really. Mr. Chenut now estimates at 700 million euros per year the increase in health expenditure to be absorbed by complementary health insurance, the structural increase in the number of acts being added to that of the co-payment. “And it’s not over,” he warns.
Health insurance and the unions of dental surgeons are still negotiating the future tariff agreement, hoped for in July, with undoubtedly an increase in costs for complementary. Negotiations are also taking place on the side of midwives, others are just beginning among nurses and paramedics.
Enough to make it “impossible” for mutuals to maintain contributions as they are. Or even to strain relations between the government and the mutualists? In April, the FNMF had deemed “inappropriate” Emmanuel Macron’s promise of full reimbursement of wheelchairs in 2024. “I’m not sure that the financial situation of all complementary health insurance is maddening”, had swept the first minister, Elisabeth Borne, urging mutuals to “not scream before it hurts”.
