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HAL Id: hal-01121272

https://hal-sciencespo.archives-ouvertes.fr/hal-01121272

Preprint submitted on 27 Feb 2015

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Does moving to a system with a more generous public health insurance increase medical care consumption?

Léa Toulemon, Laurent Davezies

To cite this version:

Léa Toulemon, Laurent Davezies. Does moving to a system with a more generous public health

insurance increase medical care consumption?. 2015. �hal-01121272�

(2)

1 /

February 2015, nº37

Health Policy Research Group

Does moving to a system with a more generous public health

insurance increase medical care consumption?

Lauren Davezies CREST

laurent.davezies@ensae.fr

Lea Toulemon

Department of Economics and LIEPP, Sciences Po lea.toulemon@sciencespo.fr

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TAUX DE REMBOURSEMENT

PRESTATIONS REGIME GENERAL REGIME LOCAL TOTAL

A. ENSEMBLE DES ASSURES

1. Honoraires et indemnités de déplacement

Médecins et chirurgiens-dentistes – généralistes ou spécialistes – sages-femmes ---

70 % 20 % 90 %

Auxiliaires médicaux --- 60 % 30 % 90 % Indemnités kilométriques --- 100 % 100 %

2. Actes techniques <120€ 70 % 20 % 90 %

=> 120€ 100 % - 18,00€ 18,00€ 100 %

3. Frais divers : Médicaments :

Spécialités irremplaçables ou coûteuses 100 % 100 %

Autres spécialités :

- Vignette bleue --- 30 % 50 % 80 % - Vignette blanche --- 65 % 25 % 90 %

- Vignette orange --- 15 % 15 %

Autres frais pharmaceutiques (accessoires,

pansements) --- 60 % 30 % 90 % Prothèses –orthopédie –optiques --- 60 % 30 % 90 % Examens de laboratoire : analyse et prélèvement

effectuée par du personnel non praticien --- 60 % 30 % 90 %

4. Frais de transport --- 65 % 35 % 100 % 5. Hospitalisation :

Etablissements publics ou assimilés :

Honoraires des praticiens et auxiliaires médicaux,

examens de laboratoire, frais de séjour --- 80 % 20 % 100 %

Etablissements de soins privés

Honoraires des praticiens et auxiliaires médicaux, examens de laboratoire, frais de salle d’opération,

forfait pharmacie, frais de séjour --- 80 % 20 % 100 % Médicaments remboursés en plus du prix de

journée selon le type de médicaments (cf. A.3) ---- 30 %,65 % 70 %,35 % 100 %

100 % 100 %

6. Frais de cure thermale :

Hospitalisation médicalement justifiée --- 80 % 20 % 100 % Cure thermale libre :

Honoraires (forfait de surveillance, pratiques

complémentaires) --- 70 % 20 % 90 %

Frais d’hébergement, frais de transport --- 65 % 65 %

Frais d’hydrothérapie --- 65 % 25 % 90 %

B. BENEFICIAIRES DU FONDS SPECIAL INVALIDITE ET FONDS DE SOLIDRAITE VIEILLESSE

Médicaments :

Spécialités irremplaçables ou coûteuses --- 100 % 100 %

Autres spécialités :

- Vignette bleue --- 30 % 50 % 80 % - Vignette blanche --- 65 % 25 % 90 %

- Vignette orange --- 15 % 15 %

Autres prestations : (honoraires – examens de laboratoire, prothèses, optiques, orthopédie, cure thermale) sauf frais de transport ---

80 % 10 % 90 %

Frais de transport --- 100 % 100 % Hospitalisation --- 80 % 20 % 100 %

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Mai 2013 source : http://www.Lion1906.com

Mai 2013 source : http://www.Lion1906.com

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Le LIEPP (Laboratoire interdisciplinaire d'évaluation des politiques publiques) est un laboratoire d'excellence (Labex).

Ce projet est distingué par le jury scientifique international désigné par l'Agence nationale de la recherche (ANR).

Il est financé dans le cadre des investissements d'avenir.

(ANR-11-LABX-0091, ANR-11-IDEX-0005-02)

www.sciencespo.fr/liepp

Directeurs de publication:

Bruno Palier et Etienne Wasmer

Sciences Po - LIEPP

27 rue Saint Guillaume

75007 Paris - France

+33(0)1.45.49.83.61

liepp@sciencespo.fr

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