Medicare’s change software! – The world

Despite higher public social expenditure in the world (32% of GDP against 22% on average in the OECD), our welfare system has led our country to the brink of social breakdown and mass unemployment. Effective during the “thirty glorious years”, the system has not been adapted to the radical change in the early twenty-first century environment. Our leaders strung reforms such as compulsory contribution, from the 1 ^st January collective supplementary health insurance policies for all employees. But they use software of the ancient world. Take the case of health.

Our health system installed in 1945 is based on the model of the welfare state, common to all of our social protection. This model provides a replacement income in case of illness and payment of care from a primary funding seated on social contributions.

This is the same system that guarantees the insured the management of health risk disease. The insured liabilities precisely because protected by a welfare state …. The other dimension of the model is the risk concern when it occurred. Upstream of the risk, the insured liabilities contributes to the financing of its labor income, for later.

Triple transition

This system has been very effective for the period after the war, participating in the economic development and improving the moral and material conditions of policyholders. Changing world in motion since the end of last century needs to go beyond the welfare state to effectively protect present and future generations.

We are witnessing a triple demographic transition, epidemiological and technological healthy. The aging population whose effects will be maximal until the 2030s raises the potential demand for care, even if the population biologically younger. The transition to the chronic state of pathologies, from medical advances and changes in individual behavior, lengthens the duration of the risk and change management software.

Genomics and its new technological derivatives constitute a key to the efficiency of health systems

Progress for mankind, these two phenomena are transforming the medical care model and place Pressure sustainable financing system capacity. By 2025, 80% of health insurance expenditure will be concentrated only on less than 20% of the population suffering from long-term illness. Health Financing the remaining 80% is not reconsidered.

This is the technology transition, dominated by genomic and digital revolutions that will bring the tools needed to manage the first two transitions . Specifying the individual predisposition to disease (genomic sequencing will cost a hundred euros by 2020) and by providing, from early diagnosis, therapeutic solutions to reduce chronic diseases, genomics and new derivatives Technology will be a key to the efficiency of health systems.

No overview

The digital promotes health education and improves efficiency of care providers. Have Internet access to their health data, compare care providers on the quality objectives and performance criteria is still not possible in France. Country of innovation, France took a significant delay in integrating these technologies into the healthcare system.

The state is trying to catch up, but no overall vision, which could bring more harm than good. Providing access to health data private funders (Health Act 2015) when neither the insured nor the doctors there have easy access is one of the examples.

This is the access to health for all to aim for with two strategies: maintaining good health and access to the best care at the lowest cost

The new world requires us to establish a proactive rather than reactive system, acting throughout the life cycle, based on the autonomy and solidarity. Make the individual, including the most disadvantaged, able to guard against the social risk, is the most effective way to protect it. The new social spending becomes partly an investment in human capital (social investment) to make every free individual, capable and independent in managing its risk.

The success of the reform is therefore suspended the democratization of the doctor-patient relationship and the general health system. This health democracy must be a priority in the governance of the system through the creation of a national agency non-state health insurance (including the current health insurance, the direction of health care provision and representative bodies of the company Civil), which will drive the entire care provision.

E-health is to develop

Health as elsewhere, the paradigm must change while respecting the fundamental principles of freedom (of choice for patients and prescribing physicians), equality and solidarity. Since 1945 and again in 2015, health policy comes down to access to care. For rich countries like France, is access to health for all to aim for with two strategic axes:. Maintaining good health and access to the best care at the lowest cost

For the first axis, an operational committee interdepartmental health management would coordinate the monitoring of the health impact of public policies influencing non-medical determinants of health (sports, nutrition, housing, ecology, transport …). Health education programs and healthy maintenance in schools and in businesses, largely using the e-health are developing. Part of the payment of 90,000 general practitioners must be adjusted capitation and dedicated to maintaining the health of their patient base.

For the second axis, the organization of the care pathway for cancer patients (reference centers, individualized care plan) is to decline on the main chronic diseases. A therapeutic contract between the coordinator and the chronic patient doctor will strengthen the effectiveness of the treatment over time. Our two-story health financing system should evolve to a single payer system by differentiating a basket of solidarity care, borne by public insurance, and individual care cart borne of a universal health insurance compulsory private and regulated.

But politicians of all stripes apply for twenty years the principle of Lampedusa (1896-1957) in his novel The Leopard “everything must change so that nothing changes “. Understanding the new world, the correct diagnosis, establish the right strategy and propose an action plan to meet the challenges are all preconditions that these policies do not meet. At this stage, there is no indication that their behavior will change by 2017!

Frédéric Bizard (Economist, lecturer at Sciences Po Paris and author of Health policy. Successfully change, Wiley, 2015)

Luc Montagnier (Nobel Prize for Medicine in 2008, co-founder of the World Foundation for AIDS Research and Prevention, together with Unesco)