High Council on the future of sickness insurance

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments Issue 3

Abstract

First stage of a process to reform the health insurance system in France, a High Council gathering all stakeholders has been set up in 2003 to build a common diagnosis on the challenges and problems faced by the health care system. At the end of January 2004, the High Council has issued a report and consultations are now taking place in order for the Government to propose legislation by summer.

Purpose of health policy or idea

An important reform of the health care and health insurance system has been announced by the Government who came into power in June 2002.

Initially planned for automn 2003, the agenda of the reform was then postponed for a year.

In September 2003, the Minister of Health unveiled a three-stage process :

• the creation of a High Council for the Future of Sickness Insurance (Haut conseil pour l'avenir de l'assurance maladie), whose task was to make a diagnosis on the health care system
• consultation with the various stakeholders involved in the system by summer 2004; and
• the tabling of a draft reform initiative by the government in summer 2004 for debate by parliament.

The High Council for the Future of Sickness Insurance was modelled on the Pensions Stewardship Council (Conseil d'Orientation des Retraites), which had been set up in 2000 to prepare the pension scheme reform. Its objective is to organise the debate between all stakeholders of the system (see below) on the diagnosis of the problems and challenges facing the health care system, and on possible solutions, in order to prepare and facilitate the negotiations and consultations led by the Government.

Main points

Main objectives

The objective is to organise the debate between all stakeholders involved in the system on the diagnosis of the problems and challenges facing the health care system, and on possible solutions, in order to prepare and facilitate the negotiations and consultations led by the Government.

Groups affected

All groups may be affected by the reform (whose content is still in a stage of elaboration)

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high

Political and economic background

The background does not refer to the High Council in itself but to the process of reform of the health insurance system.

This process takes place in a context characterised by :

1) financial difficulties : the deficit of the sickness funds have reached 11 billion € in 2003, 14 billion € are forecasted for 2004 ;

2) institutional problems :

• the main sickness fund (sickness fund for salaried workers ) accounting for 85% of the population, is supposed to be managed jointly by employers and employees unions, but the main employers organisation (MEDEF) has quit the boards of public health insurance in 2001 ;
• since 1997 the Parliament annually votes the level of expenditures of the sickness funds,  but this limit has always been exceeded in practice ;
• the State administration has taken more and more power in the system  but does not seem to be more efficient that the sickness funds in controlling costs,
• the crisis with the physicians has not been really solved despite raises in tariffs, and there has been no national agreement between specialists and the sickness funds since 1996.

Thus there is a growing consensus about the fact that the way the system is managed has to be redesigned. One important  and debated aspect of the reform will address this issue and will probably lead to a new organisation of powers in the system.

Given this background, the idea of an ambitious reform of the health insurance system was clearly announced by the Government who came into power in June 2002.

Change of government

A reform of the health care and health insurance system has been announced by the Government who came into power in June 2002.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The idea came from the Government as a part of the reform process.

What is new in the approach is the idea that this authority will facilitate the debate among stakeholders involved in the system and improve the degree of consensus and acceptance of the solutions proposed.

Approach of idea

The approach of the idea is described as:
renewed: The High Council has been modelled after the Pension Stewardship Council, an authority created to prepare the pensions schemes reform.

Stakeholder positions

The mission of the High Council is precisely to be place of debate between all stakeholders of the system and to try to bring together different viewpoints on the system

Apart from the President and Vice-president, the High Council includes :

• 6 members of parliament
• 9 representatives of the salaried workers unions,
• 6 representatives of the employers unions,
• 5 members of the State
• 3 chairmen of the 3 main sickness funds
• 3 representatives of supplementary insurers
• 5 representatives of health professionals in private practice
• 5 representatives of public and private hospitals
• 3 representatives of patients associations
• 6 members chosen as "qualified persons" (most of them having had in the past important responsibilities in the system).

Influences in policy making and legislation

Legislation will be prepared by summer at the end of the current consultation process.

Expected outcome

This is only an item in a reform process. Trying to improve democratic processes and the quality of the public debate is clearly positive to gain acceptance for reform can be viewed as globally positive.

Still the main question is the influence of this first stage of common diagnosis, endorsed by all stakeholders, on the pursuit of the process and on the final outcome. The organisations involved in the High Council agreed to some extent to write a shared diagnosis, but in further bilateral consultations led by the Government, they tend to defend their own interests and to come back to a more conservative position.

References

Sources of Information

http://www.sante.gouv.fr/ass_maladie/haut_conseil/rapport/rapport.pdf

Author/s and/or contributors to this survey

Dominique Polton (CREDES)

Suggested citation for this online article

Dominique Polton (CREDES). "High Council on the future of sickness insurance". Health Policy Monitor, April 2004. Available at http://www.hpm.org/survey/fr/a3/3