Health insurance plans to cap fees

The Board of the National Health Insurance Fund (Cnam) presented on July 13 its report “Expenses and income 2023” which makes it possible each year to formulate “concrete proposals for savings to meet the insurance expenditure objectives disease and thus guarantee the maintenance of a united, efficient and sustainable health system”.

Among the thirty proposals selected to shed light on the debates on the future social security financing bill (PLFSS), the Cnam is in favor of action “to be taken to limit high-cost remainders for families” if acting orthodontic care.

1.3 billion euros still to be paid in 2021

In 2021, according to the report, expenditure related to orthodontics represents 1.9 billion euros, of which 1.3 billion is still to be paid for, financed by households themselves to the tune of 424 million euros (i.e. 23 % of expenditure) and by complementary insurance up to 44% of the total. Compulsory health insurance pays just under 30% of orthodontic expenses.

Based on an average rate of 728 euros per semester (excluding C2S), the average remaining charge per household is estimated at 167 euros per semester. The Cnam observes that this tariff “has increased by 10%” since 2013 and notes a “significant heterogeneity of the tariff practice” throughout the territory.

Towards an overhaul of the nomenclature?

In order to reduce the rest to be borne by families, the Health Insurance suggests integrating orthodontic treatments in the 100% dental health basket, which would imply “first and foremost”, can we read in the report, to fix fees billing limits “as is currently the case for prosthetic procedures in 100% health baskets and remain at moderate expense”.

The Cnam emphasizes that this integration – likely to generate “an increase in use and therefore in expenses related to these treatments – cannot “be conceived without an in-depth and shared analysis of the situation”, in consultation with health professionals and complementary organizations.

She adds that it “could be relevant to link an evolution of care to an overhaul of the nomenclature in order to distinguish the treatments of dysmorphoses for example according to the degree of severity or even the semester number of the treatment”.

“Sustained” growth in ortho treatments

The “Expenses and products” report provides valuable data on the breakdown by performer of orthodontic treatments: “67% of these expenses are generated by the 2,100 self-employed dentofacial orthopedists (ODF), 24% by dental surgeons general practitioners and 7% by health centres. »

The momentum of this care has been “sustained” since 2013 (+4.3% per year) and the rate of recourse to orthodontics has increased in parallel in recent years (20% in 2021 against 16% in 2013).

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