Should we really double them to save 700 million euros?

François Bayrou’s government, fell on September 8, hoped to save nearly 700 million euros per year by doubling medical deductibles – 2 euros per box of medicines, 4 euros per consultation, 8 euros for health transport.

His fall suspended the planned decrees, but the question of the recovery of franchises, these fixed sums, not reimbursed by social security or by mutuals, remains at the heart of the debate. Should you ask patients to contribute more, at the risk of weighing on access to care of some? The government of Sébastien Lecornu will have to decide.

Philippe Mouiller, Senator Les Républicains des Deux-Sèvres: “Response patient and doctor”

“”The rise in medical franchises puts an important question on the table: patient responsibility and doctor. It must be thought in a general context of population aging, medical deserts and good management of public accounts. On the one hand, it is essential to develop access to care in neglected territories; On the other hand, we must find the means to finance this effort, because it has a cost.

The doubling of franchises would allow 700 million euros in savings per year. In the current budgetary situation, it is not nothing. Health spending is increasing uncontrollable in our country. On the principle, asking the insured to contribute a little more, therefore does not cause me any difficulties. The law fixes a ceiling to protect the most fragile: a patient cannot pay more than 50 euros in franchises per year.

But above all, this empowerment can make it possible to avoid certain non -essential medical acts, for the patient as in the doctor. I am thinking of a very recent experience: my son removed his shoulder and spent three radios. Why not a single one? Because medical data is going wrong. This is the substance of the debate. The rise in deductibles only makes sense if it is accompanied by a global project, a national strategy: improving access to care, strengthening medical relevance, mastering public money. The arrangements of the former Bayrou government did not have this dimension. The insured must be able to say to himself: “If I am no longer reimbursed for my paracetamol, it is for national solidarity to be concentrated elsewhere, where the needs are vital.” It is as for taxes: the French agree to contribute more provided they see that public services work. »»

Freer Aziza, Insurance-Maladie mission manager at France Assos Health: “People do not take medication for pleasure”

“The doubling of medical franchises is not a good idea. They have existed in France since 2008 and, with decline, there is no massive effect on the drop in prescription and consumption of drugs. This measure can even result in a postponement of spending on the hospital, and accentuate its saturation. It is also a deeply unfair and unequal provision. Social Security is based on an implicit contract which links all citizens: everyone contributes according to their means and benefits according to their needs.

A recent study by DREES, the ministerial statistical service, shows that in average 15 % of French income is already devoted to health. It is a crucible of inequality. The assets are better covered than retirees, who struggle to obtain a complementary health or pay for it very expensive. With the doubling of franchises, a simple round trip by ambulance would cost the patient 16 euros. Behind this figure, these are the most fragile, the elderly, modest households or patients with chronic diseases that would pay the high price. The accountability argument is often advanced. But people who take a lot of drugs do not do it for fun, they need it. Besides, drug sobriety begins with doctors, not with patients. Too many health professionals are reflexing to prescribe, without wondering how they could do otherwise.

The approach of medicine in France must evolve towards better complementarity between preventive and curative treatments. And to free up money, the public authorities could start by better taxing harmful products for health: alcohol, added sugars, junk food … It would also be necessary to end the act and favor crime, to avoid remunerating one act here and there. Before doubling the franchises, which may create renunciation of care, other ways exist. ”