a solution to the drop in healthcare reimbursements

Dental or optical care, medical consultations with a specialist, even a general practitioner, purchase of medicines… more and more French people are giving up seeking treatment for financial reasons: six out of ten, according to an Opinionway survey carried out in 2019. To fight against this social divide, the Ile-de-France region has just entered into a partnership with three health insurers to set up a regional mutual
from which all Ile-de-France residents will be able to benefit from February 1, 2023.

Pontault Combault
, Montreuil
, L’Haÿ-les-Roses
, Puteaux
, The Kremlin-Bicetre
, Fontenay-sous-Bois
… towns are also concerned about this and more and more of them are offering municipal mutual funds to their constituents. Bobigny
(Seine-Saint-Denis) will join this non-exhaustive list by the end of the year. It was a campaign promise from the new communist mayor Abdel Sadi who, at the beginning of the year, launched a major consultation with the inhabitants to find out the needs for health coverage. The time has come to choose the partner insurer who will offer a communal and solidarity mutual. The terms are not chosen at random and the mayor entrusted the implementation of the project not to the deputy in charge of health but of solidarity.

During the investigation carried out upstream, the municipality made this sad observation: “one in two families does not have mutual insurance” reveals Mohamad Aïssani, municipal councilor delegated to the Maison des solidarités. First obstacle observed: the price. “Two-thirds of the people who responded are single-parent families headed by a woman who finds herself without mutual insurance. And it’s not even eyewear or dental care that comes first among renunciations, but healthcare day-to-day, such as visits to the general practitioner, the purchase of medicines or even hospitalization”.

The future mutual partner of Bobigny will have to be established in the city and accessible to the population, “via permanence in dedicated places with interlocutors physically present, to be closer to the inhabitants. Because we see a digital divide: today everything is digitized, including access to care, while some of our citizens don’t have a computer or don’t know how to use it” says Mohamad Aïssani. The mutual selected by the city will also be responsible for detecting people who are entitled to CSS (complementary health care, ex CMU, universal health coverage) and who are out of care “because they do not have access to their rights, do not always know them and do not know how to access them. Our partner will serve as a relay to give access to CSS to those who can claim it”. In Kremlin-Bicêtre (Val-de-Marne), where residents have been able to benefit from mutual insurance since September 2021, the presence of the insurer in the city was also a non-negotiable condition there. The mutual therefore organizes weekly sessions at the town hall. “It has already received two hundred people and one hundred memberships have been registered; they cover 180 people” welcomes MRC Mayor Jean-Luc Laurent who adds that the majority of them are over 66 years old and that “20% of new members were not previously covered by a mutual. 80% had one and left because the municipal mutual was more attractive financially and in terms of healthcare coverage”.

In Bobigny, the communal mutual will be intended not only for the inhabitants and the agents of the municipality but also for all those who work there: the more the city is able to bring a large clientele to the insurer, the more it can negotiate a reduction in prices. The proposed contributions should be 20 to 25% cheaper than the market price according to the municipal councilor in charge of solidarity who specifies: “There will be several formulas offered but the mutual insurance will be the same for everyone, regardless of age. Among the questionnaires we received, I remember a case where a 76-year-old single woman paid €150 per month, which is huge, because she had serious pathologies..

The communist municipality also specifies that the chosen mutual will have to ensure a controlled annual increase in its contributions: “it is inconceivable that it offers a basic formula at €25 per month for example and that it increases to €40 the following year. Our partner must share our values ​​of solidarity and mutual aid; It is for this reason that we are very attached to the mutualist system” concludes Mohamad Aïssani.

source site-38