Pierre Aurélie, Jusot Florence
Irdes,CESP, Inserm, France.
Université Paris-Dauphine, PSL Research University, Leda-Legos & Irdes, France.
Health Policy. 2017 Mar;121(3):321-328. doi: 10.1016/j.healthpol.2016.12.004. Epub 2017 Jan 5.
In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI.
在法国，获得医疗保健很大程度上取决于是否拥有补充医疗保险（CHI）。因此，补充医疗保险的普及成为政府2013年制定的国家卫生战略的核心要素。第一项措施是在2016年1月1日将雇主提供的补充医疗保险强制扩展到所有私营部门员工，并将其对失业前员工的可携带保险范围延长至12个月。本文基于2012年健康、医疗保健和保险调查的数据，模拟了这项规定对补充医疗保险覆盖范围以及普通人群中按年龄、健康状况、社会经济特征、时间和风险偏好划分的相关不平等现象可能产生的影响。我们表明，2012年估计的未参保率将在雇主提供的补充医疗保险普及后降至4%，在考虑可携带保险范围后降至3.7%。预计最脆弱的人群更常没有补充医疗保险，而在风险厌恶程度较低和更注重当下的人群中，未参保情况将显著减少。由于该政策侧重于私营部门员工，因此对于那些最能从额外保险覆盖中受益的人群可能作用不大，而同时却扩大了那些似乎对补充医疗保险不太重视的其他人群的覆盖范围。
