Policy responses for France - HSRM


Policy responses for France

4.2 Entitlement and coverage

In the frame of the end of the lock-down period, the Prime Minister announced on April 29 that testing will now be fully covered (reimbursed at 100%), whether carried out in hospital or in community-based settings. Serological tests are only reimbursed upon a physician’s prescription while, since July 25, PCR tests are reimbursed for all even without a prescription or symptoms, including individuals who are not under the social health insurance scheme.

As part of the prevention policy, the medical consultation following a positive test of Covid-19 as well as the one for contact tracing are fully reimbursed by the social health insurance fund (100% instead of 70%).

People at risk of a severe form of Covid-19 infection, those suffering from long-term chronic conditions or pregnant women who haven’t had any physician consultation since the start of the lock-down (March 17) were able to obtain a specific consultation in primary care settings to evaluate the consequences of the lock-down measures on them and to receive advise on safe behaviours after the easing of these measures. These consultations, which cost €46 (against €25 for a regular consultation), were fully covered by the national health insurance fund. This specific form of consultation was supposed to be available until June 30 but was finally extended until September 15.

The coverage of 100% of the cost of teleconsultations by the SHI was extended on June 18 until December 31. The draft of the social security finance act for 2021 further plans that this full coverage will be extended until the end of 2021. These news were not received well by complementary health insurances who do not want to see their role durably reduced in the reimbursement of this promising new care modality.

The French government has called upon complementary health insurance companies to help fund some of the costs of the sanitary crisis for the national health insurance fund, arguing that they made strong benefits during the lock-down period due to a decrease in overall healthcare utilisation. An increase in the taxes charged to these companies is therefore to be expected in the frame of the social security finance act for 2021 (taxes of 2.6% in 2020 and 1.3% in 2021 on the collected bonuses).

The national health insurance fund covers most of the costs linked to Covid-19 treatment: in particular, a large majority of hospital costs, except a daily fixed rate of €15 to €20. These remaining costs can be covered by complementary health insurances, but nearly 5% of the population have not subscribed to one. Several hospitals have delayed the transfer of invoices to these patients in the hope that a solution can be found for them. However, concerning diagnostic testing, which is charged EUR 54, the national health insurance fund only covers 60% (upon a physician prescription) if it is carried out in community-based settings. The remaining costs not covered by the SHI are covered differently by different complementary insurance companies and contracts. Tests carried out in hospitals are fully reimbursed. The rules of reimbursing ambulatory tests changed in May (see below).

The national health insurance fund has simplified the conditions of entitlement and reimbursement of teleconsultations, which have the advantage of limiting contagion risks, and it has been announced on March 18 that 100% of the cost of teleconsultations will be covered during this period (at least until April 30) with the suppression of all out-of-pocket costs. Moreover, Doctolib which is the biggest company for online medical appointments, has decided to provide its services and platform free of charge to 80,000 doctors during the confinement period. Before, only 3,500 practitioners had subscribed to this service. Physicians are now allowed to use such mode of consultation without having to already know the patient or outside of the usual recommended care pathways, which was not possible previously. Concurrently, this possibility has been opened to nurses for the follow-up of patients infected by the Covid-19 virus confined at home. By mid-April, teleconsultations were also opened to midwifes, speech therapists, occupational therapists and psychometricians for all their patients without any restriction. Physiotherapists were the latest professionals to benefit from this new modality on April 18. The frequency of teleconsultations during the Covid-19 outbreak has been increasing exponentially: about 40,000 teleconsultations were counted just in one day (March 23, week 13), representing around 10% of all consultations, while this is usually the number of teleconsultations reimbursed over a one-month period (1% of all consultations). In addition, to respond to the needs of people who have no internet access (frequent among the older population), the Ministry of Health announced on April 4 that consultations through phone calls will also be reimbursed as normal consultations during the Covid-19 epidemic. They are, however, limited to patients with Covid-19 symptoms, aged over 70 or those in the long-term illness scheme for chronic disorders (affections de longue durée, ALD). While such telephone consultations were stopped after the end of the lock-down, they were re-implemented during the second wave of the epidemic.

A number of other specific measures to facilitate access to care for vulnerable groups during the Covid-19 epidemic have been set up. They include derogatory mechanisms for migrants benefiting from the state medical aid (aide médicale d’état). This aid will be prolonged during the epidemic (automatic extension of three months for all individuals whose rights were initially planned to end between March 12 and July 31), even if it legally comes to an end. Similar measures were implemented for individuals with chronic disorders who benefit from the long-term illness scheme (ALD) which exonerate them from co-payments for services or drugs linked with the treatment of their condition. The ALD status of all individuals concerned will be prolonged automatically during the Covid-19 outbreak without a visit to gatekeeper physicians. French citizens who were repatriated from abroad will benefit from the social health insurance without any delay. On April 9, a free hotline for homeless people and people working with them has also been set up by the ‘Accès aux droits des sans-abris’ association, to provide medical advice to those with Covid-19 symptoms and call emergency services if deemed necessary. Concurrently, the government has opened 88 residential centers for homeless people infected by the coronavirus but whose health state does not require hospitalization.

Progressively, the national health authority (HAS) is issuing guidelines, in collaboration with medical experts and patient associations, regarding the optimal care and modalities of care of vulnerable groups (including pregnant women or individuals with mental disorders) during the Covid-19 epidemic. The HAS also extended the right to use abortion pills from week 7 to week 9 of pregnancy, considering the rising concerns about the difficulties accessing abortion procedures during the epidemic. There are, nevertheless, increasing worries regarding the care of individuals with chronic disorders, as many of them have stopped consulting their physicians due to fear of contracting the virus. The health insurance fund noted a significant reduction in all sorts of health care utilization (that is, visits to all type of physicians) during March 2020. The Minister of Health now communicates on the importance, for patients with chronic disorders, of visiting their physicians for the follow-up of their disorders during confinement.