Long-term health patients fear reimbursement reforms in France

A group of 25 associations have written a joint open letter to France’s Health Ministry, citing fears over changes to special health coverage for long-term illness sufferers, such as cancer or Alzheimer’s patients.

It highlights concerns over the potential “dismantling” of the current system, giving examples of why the funding is critical and claims long-term illness sufferers are being made to feel guilty for costing money.

The letter – which you can read here – was published yesterday (March 6), and comes after comments made by Health Minister Frédéric Valletoux about potential changes to how long-term illnesses are treated.

“It is neither illegitimate nor illogical... to question the relevance of these schemes,” he said to MPs in the Assemblée nationale.

He confirmed that a review of the current systems was underway and could lead to changes.

“We should be trying to avoid chronic diseases rather than cutting costs. We are not going to make the sick disappear by revising reimbursement,” said Féreuze Aziza of France Assos Santé, one of the letter’s signatories.

Government urges savings across board

Patients who suffer from certain recognised long-term illnesses in France, known as Affections de longue durée (ALD) make up about 20% of the population, or 13 million people. They include cancer, Alzheimers, Parkinsons, strokes causing disability, serious heart illness, HIV, diabetes, severe high blood pressure etc.

Unlike other patients, who are only partially reimbursed by social security payments from Assurance Maladie and must cover the remainder through top-up insurance, most people with an ALD have their medical fees reimbursed at 100% of the basic state rates.

They do, however, still have to pay the additional fees (dépassements) some medical professionals are allowed to charge over and above the state rate, as well as such non-reimbursable elements as the franchises médicales (levies taken off medicine reimbursements to fund the health service) or the daily forfait hospitalier fee for stays in hospital.

There are certain ALDs which do not qualify for this '100%' reimbursement system, but this is less common.

According to Mr Valletoux, two-thirds of social security reimbursements concern ALDs. “We also know that… with the ageing of the population and the rise in chronic pathologies, costs are only going to increase,” he added.

These medical deductibles include the franchise médicale, a non-refundable surcharge paid on medicine (up to an annual limit), and the dépassements d'honoraires (excess fees) charged by doctors. You can find a list of other costs not reimbursed here on the Assurance Maladie website.

The letter states that ALD patients spend on average twice as much on healthcare than non-ALD patients (€772 compared to €440)

Read more: How do French healthcare costs change for long-term illnesses?

The government is seeking to save around €10billion from its annual budget.

A number of cuts – including to hospital transportation by taxi for patients – have already taken place as part of the 2024 Social Security budget.

Read more: French airports blocked as new taxi protests held in several cities

Economy Minister Bruno le Maire has also said “the increase in expenditure linked to long-term care” needs to be rectified, but no concrete announcements have been made.

Testament to French welfare

For many, however, these costs are justified, and associations want the government to take pride in its robust welfare state.

Renaloo, an association for kidney disease patients which also signed the letter, gave an example of how this expenditure saves thousands of lives;

“The survival of dialysis patients costs an incredible amount of money – almost €63,000 per year per patient – but that is a credit to our country,” it said.

"This allows 57,000 people in France to stay alive, even though their kidneys are no longer functioning.”

Long-term changes may be the solution

“We fully agree with the observations of the health minister,” over the increase in costs for ALD patients, said Ms Aziza.

As people live longer, the percentage of people with ALDs including cancer and dementia will increase.

However, the associations believe prevention is the solution – “the courage to invest over the longer term… with a multi-year vision of health funding,” will save money and improve care in the long term, Miss Aziza added.

Related articles

How do hospital fees work in France?

Explainer: French healthcare terms that are useful to know

Medicines in France will cost patients more from spring