Towards A Professional Rationalization.

Abstract

I The French Health Care Financing And Delivery System FINANCING and provisions are a mixture of public, private and contracts mainly between professionals and the State or its representatives. National Health Insurance is one element of a large National Social Security System (N.S.S.) which is also responsible for retirement pensions and family allowances. In the health care field, the financial crisis of the welfare state is accompanied by relative consistent growth of the for profit sector (Huard, et al.). But, at the same time, the control of the State is stronger than it ever was. As is well known, French health care is financed by a National Social Security system which is compulsory and financed by the workers and their employers. After having been constantly extended over the years, today almost 100% of the population is covered by this national system. Unemployed and certain groups of workers (such as Miners or Craftsmen) still remain covered either by the State or by special insurance plans which predated the complete integrated system of today. These special insurance plans are facing chronic deficits because of the disequilibrium between the numbers of working and retired members of these declining professions. However, the plans are still maintained for historical reasons and because they give their members certain advantages, they are likely to lose by joining the general insurance system. From an institutional point of view, the, N.S.S. is an independent and non profit organization managed by representatives of the employers and the labor unions. Currently, however the State plays a great part in its regulation. By coveting the annual so-called deficit, determining along with the professionals the main unitary health care prices, regulating the financial compensation between several health funds, etc., the State supports the framework of the whole system. Membership of the public health insurance system is compulsory for all working people and the premium, the major part of which is paid by the employers, is a fixed percentage of the wages. The share of such a charge in overall manpower costs is 2.3 times higher in France than in the U.S or even in some other European countries (Concialdi, et al.). At a time and, under circumstances when, as a result of the enormous growth of international trade, a firm's and a nation's competitiveness are of universal concern, this phenomenon plays against the increasing of health care expenditure. As a result, there is increasing suspicion of the idea that growing expenditure has to be balanced by growing worker contributions. Also, there is a growing concern about what is called the fiscalization of the Social Security System, the aim of which will be to shift gradually the financing basis from wage earners to taxpayers. The advantage of this new procedure will be to insulate, at least in the short term, the flow of the N.S.S. revenue from the increasing amount of unemployment and from wage stagnation. Economists have computed that, ceteris paribus, a 0.3% decrease in the wages paid in France would result in a 3 billion FF loss in N.S.S. receipts. Thus, the introduction, in 1990, of the Contribution Sociale Generalisee (General Social Contribution) has to be considered as a real innovation. For the first time, N.S.S. funds are directly and formally provided by means of a new tax, instead of by an increased rate of contribution. From an equitable point of view, such a tax will be seen as closing the gap between costs and taxes related to work or consumption. Another and more classical way of decreasing social charges is to encourage workers and households to contract for private health insurance on a voluntary basis. Since the national health insurance has always worked with a co-payment mechanism (around 20%, depending on the type of care), there has always existed private and essentially non profit-making insurance companies offering to reimburse the co-payment. …