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Universal Health Insurance (CMU) in France

This article provides an overview of the Universal Health Insurance (CMU) program in France, including its background, implementation, and impact on access to health services. It discusses the characteristics and data of CMU beneficiaries and highlights the improvement in access to specialized health services and overall health state. It also acknowledges room for improvement in achieving equal access for equal needs.

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Universal Health Insurance (CMU) in France

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  1. Universal Health Insurance (CMU) in France Martine M. BELLANGERmartine.bellanger@ensp.fr ENSP RENNES

  2. Contents • Background & implementation of CMU • Some characteristics of the beneficiaries • Impact on access to health services

  3. Background • Q Universalism:1998 Act related to tackling exclusion” • “access for all to all fundamental rights, such as employment, housing, education & health • Under the “health umbrella” of 1998 ACT: two provisions • R Creating a Universal health insurance • R Implementing regional programmes for prevention and access to health care for people suffering from deprivation (PRAPS)

  4. CMU • Introduction of a Universal health insurance (CMU): 1st January 2000. • CMU allows the neediest members of the society residing lawfully in France to be covered by the national health insurance coverage - ‘General Scheme’, irrespective of their employment status

  5. ‘CMU basic package’ • A basic package of good and services was defined ‘ a priori by law’ for the CMU beneficiaries. This package includes services such as: • In patient and ambulatory services • Optical and dental care, • Implants (e.g. earrings)

  6. ‘Complementary CMU: CCMU’ • In addition to the CMU basic package • A free complementary coverage is provided on a third party payer basis • for people below an income threshold (€587: £ 391 per month for a single person, in 2006) • who are exempting from making the initial direct payment, from hospital flat rate fee (€16: £10.7) and from out-of-pocket payments for spectacles and dental care

  7. Beneficiaries: some data • 1.7 Millions people for the ‘basic CMU’, i.e. 2.8% of the whole population, 1st January 2006): • 4.7 Millions for the CCMU, i.e. 7.6% of the whole population • 44 % of the beneficiaries of the CMUC are less than 20, and 4% more than 60

  8. Beneficiaries: some data • Large regional disparities for both CMU & CCMU, between France & oversea departments • CMU: 2.3% in metropolitan France, versus 16.8% in overseas departments • CCMU: 6.8% in France versus 33.5% in overseas departments • Large regional disparities within France • From 3.3% in Haute Savoy to 12.7% in Seine-Saint Denis (Paris Suburb) • Higher level coverage rates in a crescent South-South East and in North of France (see map: following slide)

  9. Beneficiaries: some data • CMUC Beneficiaries and Activity Minimum Revenue (RMA) Beneficiaries: • Strong relationship between these two variables: • Correlation coefficient r = 0.95 in 2005 (0.82 in 2000)

  10. Impact of CMU on access • Breakdown of CMUC spending (in 2006) • 50% ambulatory care and drugs • 25% hospital services • 15% dental care • 20% (others such as spectacles, implants) • Improvement in access to specialized health services (e.g. dental care, prosthesis, optical care) • Increase of specialist consultation in outpatient settings (instead of hospital setting after A&E)

  11. Improvement of health state • Perceived health state lower for the CMU beneficiaries than for the rest of population (12% declared being in ‘bad health’, versus 4%, in 2003) (Same finding in the National health survey 2004) • But some improvements: • 30% declared suffering from a chronic disease, versus 37% the year before • Oral health conditions improved for those beneficiaries, in comparison with previous results

  12. For further discussion … • Still some room for improvement (e.g. equal access for equal needs) • This scheme was called ‘UNIVERSAL’ but a specific basic package was defined for the neediest of the society, with a risk of stigmatising these ‘peculiar citizens’ • It could be said that the CMU aims to give the maximum to the worst off, according to the MAXIMIN Rawls principle

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