Pricing that is meant to be more readable. From Saturday January 1, 2022, patients who go to the emergency room without subsequently being hospitalized will have to pay an “emergency patient package” at a single rate of 19.61 euros, if possible on site the same day. This rule was included in the Social Security financing law for 2021. But its application has been postponed to January 1, 2022. Ce “package” replaces a variable rate, but payable weeks later, which gave “the illusion of free”, according to the Ministry of Health. What will this measure, the decree of which has just been published in the Official Journal, change? Explanations.
What is changing?
Until December 31, 2021, a patient who went to the emergency room without being hospitalized received a few weeks later an invoice sent to his home by the hospital. The bill amounted to a minimum of 25.28 euros. A sum due under the “reception and treatment” package in emergencies, explains the Directorate General of Health (PDF file). In most cases, it was necessary to add other types of care, which added to the bill.
On this invoice, About 80% were covered by Medicare. The patient was responsible for “co-payment”, up to 20%, sometimes more depending on the examinations carried out. For the 95% of insured who have complementary health insurance, this remaining charge was reimbursed, in whole or in part, by the mutuals. The others had to pay out of pocket.
From January 1, 2022, the bill for a visit to the emergency room without hospitalization will amount to 19.61 euros, regardless of the treatment provided. This is a single rate, not reimbursed by Social Security, which must be paid on site. This remaining charge will be paid directly by the mutuals (if you have your card with you), or reimbursed subsequently. Otherwise, this amount will have to be paid.
Does this reform really apply on January 1?
Yes for the new calculation, which applies from January 1, underlines the General Directorate of the provision of care (DGOS) of the Ministry of Health. But not for the terms of this payment of 19.61 euros: “Hospitals will not be required to charge patients right away. They can continue to mail the bill until they adjust.”, said the Ministry of Health, Tuesday, December 28, during a press briefing. “Immediate payment was inapplicable “, confirms the Hospital Federation of France to franceinfo.
Another clarification: this new device does not involve filtering in emergencies, according to the Ministry of Health. “Everyone is received in the emergency room, even without a vital card or means of payment. There is no subject”, assures the DGOS, questioned on this point by the press.
Who is at risk of being penalized?
It depends on the nature of the examinations and the treatment provided. Before January 1, the remainder of the charge for patients was “on average 10 euros, but could go up to 60 euros, or even more”, according to the DGOS. From 2022, this remaining charge rises to almost 20 euros for everyone. The bill will therefore be increased for the most frequent cases, and reduced for the heaviest care (without hospitalization).
Why, moreover, was the sum fixed at 19.61 euros? It’s about a calculation of “smoothing to avoid large deviations”, explains the ministry. “The patients will not pay more in their totality, neither the health insurance, nor the mutuals”, he assures.
The only people who will ultimately foot the bill are those who do not have a mutual fund. More than 95% of the population benefits from complementary health insurance, according to one study (PDF) of the Research Directorate (DREES) of the Ministry of Health dating from 2019. There are still some 3 million low-income people (precarious workers, unemployed or inactive) who do not have it. Means-tested and if they have requested it, these households may nevertheless have access to the Supplementary solidarity-based health (created for the most modest households). In this case, the “emergency patient package” will be taken care of.
Can we be exempt?
Yes, some patients are exempt from this “fixed price” patient emergencies “. These include, according to the Ministry of Health, “insured persons benefiting from maternity insurance (from the sixth month of pregnancy), victims of work accidents or occupational diseases with an incapacity of at least two-thirds, invalidity pensioners, newborns within 30 days of their birth, minors victims of sexual violence for treatment following abuse suffered, organ donors for all acts related to their donations, victims of acts of terrorism for treatment related to the act of terrorism “.
Who will be able to benefit from a reduced rate?
People with a long-term illness (ALD) and beneficiaries of the work accident and occupational disease scheme with an incapacity of less than two-thirds. These policyholders will be applied a reduced amount of 8.49 euros for the “emergency patient package” .
How does the ministry justify this reform?
The first objective put forward by the Ministry of Health: the clarification of the cost for patients. UA single tariff, he believes, is more understandable for policyholders. “The complexity of billing for emergencies means that today there is a sort of illusion of free”, explained its representatives during the press briefing.
“Emergency room patients sometimes had trouble perceiving that there was always an out-of-pocket charge because it was billed long after the episode of care, so with a time lag.”
The Ministry of Healthin a press briefing on December 28
This single rate will also simplify the task of hospitals, with administrative time savings, argues the DGOS. “Until then, the administrative and medical teams of the establishments had to wait until they had consolidated very disparate and diversified information“to provide the billing, synthesized the Ministry of Health. This will no longer be the case, with a quick bill to establish.
Third motivation: by asking people to pay the emergency package on site, “we also expect a recovery gain”, recognizes the ministry. The sum of “35 million euros (of recovered debt) was mentioned in the Social Security financing law for 2021, but this amount has not been recalculated since “, he adds.
Fourth objective, finally, to encourage patients to prefer other solutions than emergencies for treatment.
“Of the 22 million annual emergency visits, 14 million are not followed by hospitalization.”
The Ministry of Healthduring a press briefing
“If we can encourage people not to go to the emergency room by doing a form of education on the cost, that’s pretty good”, We are still arguing on the side of avenue e Ségur. Posters should also be affixed to emergencies to communicate on this cost as well as on exemptions and reduced tariffs. But will this communication be dissuasive, as long as there are no alternatives? Launched in 2021 and supposed to guarantee treatment “everywhere and at any time”, the access to care service (SAS) is still only in the test phase, admits the Ministry of Health, and the site is behind schedule.