In the context of the 100% health reform initiated in June 2018 by Agnès Buzyn, Minister of Solidarity and Health, health insurance plans must adapt to a new specifications by 2020-2021. Among the 20% of French people with the lowest incomes, about 1 in 5 of them give up optical equipment and almost 1 in 3 give up dental care for financial reasons. The abandonment of care for financial reasons is therefore still too prevalent in France today. In the face of this, this new reform must be able to create de facto solidarity. While the benefits to patients are significant, the consequences for health care professionals are multiple in the dental, audiology and optics sectors with a significant charge transfer risk.
100% health reform, a new solidarity
Health is one of the main concerns of the French and generates a high level of inequality. The “100% health” reform aims to offer baskets of care without dependants with a guarantee of quality to the insured. The reform must continue gradual steps, beginning on 1 January 2019, and must be completed in 2021 with a full refund. The roll-out of the reform must be carried out through the conventional networks of mutualists in the field of optics, audio and dentistry. However, if complementary bodies appear as facilitators in the context of this reform, the concern of mutualists lies at the level of the transfer of burden that would weaken their activity. In the case of Mutual Harmony, members will be able to use its Kalivia-agreed network as part of a zero or controlled rest-to-charge. The automatic payment of an additional benefit will thus allow compensation to be made in the cost differential. This new solidarity is also expressed by offers from health care facilities in territories marked by medical desertification. For example, La Creuse and Lot-et-Garonne are territories hard hit by the shortage of doctors.
New Aquitaine territory ahead of 100% health reform
In the South West, Mutual Harmony is a brand present in the region. A non-profit organization, Harmonie Mutuelle operates through a network of delegates who ensure a permanent relationship of closeness and solidarity with its members. Thus, at the local Aquitaine level, more than 300 elected volunteers represent and make the voices of members heard in the fields of solidarity, social action and health prevention. Through a comprehensive insurance offer, Harmonie Mutual protects nearly 214,318 people in the Territory of New Aquitaine and has about 8318 member companies. With a view to embodying a social protection player, Harmonie Mutuelle has signed a partnership agreement with CFDT Aquitaine to ensure quality of supply and cost control. As a part of this important B2B clientele, Harmonie Mutuelle launched in 2015 an innovative program “Health wins the business” which proposes to support companies in their approach to health prevention. Since Harmonie Mutuelle is engaged in a health prevention mission, it wanted to implement in New Aquitaine, the reform of the zero-burden of the remains of charge from 1 July 2019 in optics, dentistry and audiology, almost two years ahead of the government’s timetable. It therefore seemed natural for Harmonie Mutuelle to promote the transition to the rest-to-charge-zero due to its status as a privileged interlocutor with local actors of health, solidarity and the associative fabric. A true player in the social and solidarity economy, Harmonie Mutuelle supports social innovation in health in New Aquitaine for both businesses and individuals, as desired by Stéphane Kergoulay, Director of the South-West Region of Mutual Harmony. Thus, driven by an approach that places the human at the heart of health thinking, Harmonie Mutuelle is a signatory to the Charter of Diversity in Business and has set up the Mission Equality of Opportunity and Diversity which intervenes in the fields of professional equality, disability, volunteering skills and the integration of young people
Mutuals are therefore partners of choice to facilitate the understanding of 100% health reform among individuals and businesses. A real relay of public authorities in the field of health, their social action is essential in a strategy to develop the provision of care and access to all. As part of the reform, complementary bodies have been sponsored to strengthen the legibility of their contracts and offers in order to give policyholders greater freedom of choice in the interests of transparency. In parallel to this reform and already initiated since 2017, Harmonie Mutuelle strengthens its support to companies with services dedicated to prevention and quality of life at work, not only to limit companies to regulatory constraints but to promote a real health action plan throughout the territory.
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