Health Insurance publishes new figures on 100% health in optics (rate, anomalies observed in store, etc.)

Health Insurance has just put its 2022 Costs and Income report online, which details, among other things, the effects of the reform in our sector (with data from 1er semester of this year) and makes proposals for changes to the system for 2023.

The share of 100% health equipment has changed little

At 1er quarter of 2022, the share of lenses and frames in basket A, including for C2S beneficiaries, was 16% of total lenses and frames, compared to 15.1% in 2021 and 13.9% in 2020. share of equipment including at least one 100% healthcare device out of all equipment delivered was 18.1% in the first quarter of 2022, compared to 17.2% in 2021 and 15.8% in 2020.

The reform does not change the pace of equipment

From January 1, 2020 (date of implementation of 100% healthcare) to March 31, 2022, 4.7 million patients benefited from 100% healthcare in optics (including those covered under C2S) over a total of 29.4 million fitted with lenses or frames over this period, all baskets combined. The total number of patients who used optical equipment (lenses and/or frames), regardless of the care basket, was 15.5 million in 2021, including 2.6 million beneficiaries of the 100% health offer . ” Since the implementation of the reform, the overall number of equipped patients has not increased more rapidly than during the previous period “, notes the Health Insurance. In our sector, 1.3 million patients were equipped monthly on average in 2021 (all baskets combined), i.e. a number close to that of 2019. ‘Health insurance decrease. These situations represented 6% of the total number of cases of renunciation of care handled by these missions in 2021, compared to 12% in 2019.

Optical health insurance reimbursements focus on 100% health

In 2021, the total expenditure for lenses and frames, all baskets combined, amounts to 6.8 billion euros, including 359 million euros for 100% health (5% of the total). The amounts covered by Health Insurance amounted to 71 million euros, including 68 million euros for basket A alone.

Abnormalities observed in nearly 1 in 2 stores

At 1er quarter of 2022, according to the checks carried out by Health Insurance, the ceiling prices for 100% healthy lenses and frames were respected in 99.8% of cases. The report also reviews the support and checks carried out at opticians as part of the implementation of the reform. In September 2021, 10,600 opticians received a letter inviting them to continue their efforts to present the 100% health offer. From September to November 2021, 9,300 were visited by a Health Insurance representative who advised them. In addition, a control action was carried out in 49 departments in stores where the rate of 100% health is the lowest at the national level. As of June 23, 2022, out of 192 stores checked, 85 of them complied with the rules for presenting the offer or showed a very slight deviation from the regulations. Anomalies were noted in 107 points of sale: 74% concerned the presentation of frames in basket A, 18% the presentation of 100% healthy frames AND the offer on the quotes, 8% the presentation of the offer on the quotes . 34 financial penalty decisions were taken by Health Insurance, for an average amount of €2,187. For the other stores, the contradictory procedure is still in progress.

Health Insurance proposes to change the 100% health basket

According to a study carried out using 2021 reimbursement data on highly corrective lenses (greater than ± 12D), the rate of patients wearing lenses outside the 100% health scope is 78%, all age groups combined. . ” The health need for corrective lenses would only be partially covered for approximately 30,000 patients “, notes the report. Health Insurance also cites the case of glasses that slow down the development of myopia, which meet a public health need but are not offered in class A. It suggests considering the integration of these two types of products in the 100% health nomenclature, which would involve additional funding of 5 to 10 million euros.

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