The President o the Republic said in Bordeaux be ore the General Assembly o the rench mutuality: or health expenditures, "We must identi y sources o unding that are both air and consistent with the growth o our economy", the additional health, which today inance 13 o health expenditure, approximately EUR 30 billion, will be called to play a more important role. Elles to ease burden on mandatory health insurance plans. And the complementary insurers argue that they know better manage risk than their public counterparts, with or example the possibility o establishing networks o recommended pro iders. But should be complementary health " ertical" or "horizontal"
The "horizontal" option is to reintroduce the complementary support o the hea y risk, which they ha e been excluded gradually o er time, irst in the 1950s with support 100 most o the hospital and then, in the 1970s, with what became in 1986 the "diseases o long duration" de ice (ALD)which exempt the co-payments insured.
Con ersely, there is a " ertical" option which radicalised current de elopments by entrusting to the complementary co erage "to the irst euro" o certain types o care, including those which are already the main unders (the dental and optical), with a national speci ications to a oid some per erse e ects such as the selection o the insured.
Each option has its ad antages and disad antages. The horizontal option a oids a di ision o labour that could emerge between uni ersal public insurance specialized in serious pathologies and pri ate insurance co ering minor diseases. This could threaten the coherence o the system and the solidarity, the (relati ely) healthy and (seriously) ill under two di erent systems. 9 Million people - or 15 o the population - are in ALD (1 million new bene iciaries each year) and they already represent more than 60 o the expenditure o public unds.
The ertical option rati ies a act situation (the symbolic part o the public re unds) and allows additional insurers to de elop independently o true policies o management o risk with selection o pro iders, quality standards, etc.
The majority o the "commercial" insurers (25 o the market), the irst euro management is the core business, is rather to the ertical option. rench mutuality (57 o the market) made known his desire to better participate in the support o "chronic diseases", which indicates a pre erence or horizontal. But it claims, in return, a co-directorship o the policy o support, with seats in the decision-making bodies and access to public data or reimbursement. Pro ident institutions (18), joint pro it organizations not ery present in the pri ate sector, are reluctant.
But no solution will be possible as long as there was no will answer a second question: is the growing inter ention o complementary intrusi e to airness and equality o access to care
I it contributes to equal access to care by lowering the rest dependent households, supplementary insurance howe er generates two types o inequality: between unprotected and protected on the one hand, persons and in the latter on the other hand. This is why one can think that any signi icant trans er o spending is politically iable i it is accompanied by two counter ailing measures: the uni ersalization o the additional co erage and the de inition o a basket o identical minimum guarantees or all. In other words, it is "pri atisera" health spending only on condition that it take the same characteristics o uni ersality and uni ormity than the public protection which it o errides! There are at least two pre ious pension additional employees rames and non-executi e pri ate but uni ersal and mandatory, as well as the CMUC, which is a ree supplementary insurance (subject to resources) on a basket o sa eguards de ined in ad ance.
Howe er, i this is the case, need to show much imagination to keep the premiums or such contracts compulsory le ies - and much attention to a oid bureaucratic supplementary insurance by the multiplication o crippling regulatory constraints.