Florence Jusot is Professor of Health Economics at the University of Paris-Dauphine. She participated in collaborative work with the College of Health Economists The French healthcare system today, problems and challenges (Eska, 2021). This health spending specialist recalls that the deductibles for prescribed medicines introduced fifteen years ago, the increase of which the Head of State Emmanuel Macron defended this Tuesday, January 16, do not have the same effect for all patients.

After several months of hesitation, Emmanuel Macron has just advocated an increase in deductibles, that is, those amounts that remain the responsibility of patients, in particular for each box of medicine purchased, and which could rise from 50 cents to 1 euro. Are you surprised?

Not very much. Health spending is increasing and, given this trend, public authorities are faced today, just as in 2008, with the creation of franchises under the presidency of Nicolas Sarkozy “authorize” the patients. However, this message seems quite ambiguous to me. It dispels suspicions of “over-utilization” of care. But in relation to what? On average? Has a medical standard? Some patients certainly consume unnecessary care, but we also know that late utilization of the healthcare system, poor follow-up care, refusals for financial reasons, etc. occur and therefore lead to “underconsumption”.

The increase in healthcare spending is not necessarily a sign of dysfunction: it can also be explained by population aging and therapeutic innovations. The challenge is to find new sources of funding: that is the challenge for the government.

Are these deductibles specific to the French healthcare system?

They can also be found in many other countries – Switzerland, the Netherlands, the United States… But deductibles have their peculiarities in France: a very small amount applies to all patients – or almost – and affects the entire treatment, i.e. the medication, but also the consultations. [qu’on appelle « participations forfaitaires »], for medical transport… These deductibles are added depending on the care received. In most countries, the system works differently: the patient has to pay the first 150 or 200 euros of unreimbursed healthcare expenses of the year before being covered for the rest of their annual expenses. A bit like a car franchise whose name was also adopted. The name therefore covers very different realities.

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