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 The Costly and Progressive Disappearance of Complementary Health Insurance


Etienne CANIARD * Organisateur des États généraux de la santé en 1998 ; membre du premier collège de la Haute Autorité de santé (HAS) en 2004 ; président, Fédération nationale de la mutualité française (FNMF) jusqu'en 2016. Contact : e.caniard@wanadoo.fr.

The role of complementary health insurance organizations (OCAM) is being questioned as they develop. They have gradually taken on an essential role, as the rate of refusal of care doubles for the fortunately few people who still do not have any. Considered more as adjustment variables for the disengagement of the health insurance system from routine care than as partners of the compulsory schemes, they are denied any role in the regulation of medical care expenditure.

After a review of the conditions of their development, the consequences of the inconsistencies of their economic model will be illustrated. Indeed, the preference given to group contracts and to a form of competition leads to risk selection and therefore to exclusion.

Finally, the various solutions recommended by the High Council for the Future of Health Insurance and by the Court of Auditors will be critically examined, as they do not seem to meet the challenges of health policy.