title: The likely effects of employer-mandated complementary health insurance on health coverage in France.
abstract: In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI.
authors.affiliation: Irdes,CESP, Inserm, France. Electronic address: pierre@irdes.fr.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Pierre
authors.affiliation: Université Paris-Dauphine, PSL Research University, Leda-Legos & Irdes, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Jusot
mesh_terms: D000328:Adult; D005602:France; D033161:Government Regulation; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D037141:Mandatory Programs / Q000191:economics*; D008875:Middle Aged; D017149:Private Sector / Q000191:economics; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Complementary health insurance; Inequality; National Interprofessional Agreement; Simulation