Dérembourser des soins pour maîtriser la dépense de santé : qui paie ?

In a context of deficit in the health insurance branch, partial reimbursement cuts are often presented as a cost-saving lever, particularly given that France stands out for having some of the lowest out-of-pocket expenses in the European Union. Using a microsimulation model, this study compares several scenarios calibrated to generate 1 billion euros in savings and assesses their redistributive effects. In France, healthcare expenditure within the scope of the social security tariff is broken down into three components: the share covered by compulsory health insurance, the cost-sharing rate (ticket modérateur) generally covered by supplementary insurers, and flat-rate copayments and deductibles borne by patients. While an increase in the cost-sharing rate is pooled through supplementary health insurance premiums, flat-rate copayments and deductibles directly increase out-of-pocket costs, disproportionately burdening individuals in poor health. Retirees, meanwhile, remain exposed to significant premium increases when the cost-sharing rate applies to healthcare services they consume more heavily. Regardless of the scenario, the financial effort relative to income is twice as high for low-income households as for affluent ones, with the solidarity-based supplementary health insurance (C2S) providing only partial protection. A general increase in levies financing compulsory health insurance would be less regressive, but would weigh more heavily on workers, with potential consequences for labour costs.