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Optics, dental: the first failures of the rest at zero charge

Since 1st January, the reform of “100% health” or the rest at zero charge has taken a major step: glasses and certain dentures are now fully reimbursed by the Social Security and complementary health insurance. But against all odds, while waivers of care are particularly frequent in these health sectors, the French are still far from rushing for these “100% health” offers. The reason for this delay in ignition? “The vagueness surrounding the reform, as much on its calendar of application clocked over three years as on its financial repercussions, is a brake”, explains Olivier Moustacakis, co-founder of Assurland.com.

© All Rights ReservedHealth: what the “zero charge remains” provides for glasses, dental and hearing aids

According to a survey * carried out by the insurance comparator, published this Thursday, February 13, 70% of French people have heard of the reform, but 35% do not think they will benefit from it. “Our survey shows that 42% of these people are convinced that they are not entitled to the rest at zero charge, while the only condition to benefit from it is to have complementary 'responsible' health care, which represents around 95% of contracts “, notes the expert. For 28% of those polled, they clearly admit that they did not understand the reform.

“100% health is a gas factory, even for professionals”, abounds Olivier Moustacakis, citing as an example the nomenclature of acts on the dental, where reimbursement depends on the place of the tooth or the materials used for the prosthesis. “The effects of this reform will be measured over time, by observing the decrease in the rest of the charges for patients and the increase in the use of 100% health equipment”, stated Nicolas Revel, director general of the Cnam, at the end of January, before the Association of Social Information Journalists (Ajis). “For the dental sector, we noted a drop in reimbursed procedures at the end of 2019, which undoubtedly indicates an anticipation of the reform on the part of certain patients.” The objective, he recalls, is to achieve almost half of the 100% healthy dental procedures.

After-sales service of the reform

From the point of view, the beginnings of the rest at zero charge are not simpler. In the field, indeed, many opticians recognize that they must do the after-sales service for this reform. “We see an interest from our customers, but we have to show a lot of pedagogy,” explains this Parisian optician. Another, located in Saint-Etienne in the Loire, gets annoyed in the columns of Progress: “We spend more time explaining the law than selling glasses!” Once this stall period has passed, on the other hand, 100% health sales should take off. According to Xerfi's forecasts, more than 1 million people will have to wear glasses for the first time thanks to the reform over two years, including 500,000 by 2020. The “zero RAC” basket would represent 15% of the market global optics.

In the meantime, the technical hiccups that hinder good transmission between opticians and complementary health do not help. “The implementation of 100% health has coincided with the deployment of the standardized quote among opticians, who are now required to offer their customers a basket A proposal (the offers of frames and glass falling within the scope of the rest to charge zero, Editor's note) and a proposal at free rates “, notes Olivier Padieu, the new president of Optic 2000, who replaced Didier Papaz in January. In addition, a new framework for the information to be included in these quotes, resulting from the GDPR personal data protection law, was implemented simultaneously. “New codes, called grouped, have been put in place to limit the level of detail of the information transmitteds complementary health, for example on visual corrections “, underlines Olivier Padieu.

All these technical revolutions ended up telescoping. “The government having delayed communicating its specifications, point-of-sale software publishers were not all ready on D-Day,” deplores Stéphanie Dangre, president of Groupe All, the central purchasing agency for independent opticians, in a column published in The echoes.

Pending files

In terms of complementary health, the new nomenclature does not pass. The organizations state that they need detailed information to ensure that the price ceilings provided for in the reform are respected. Mutuals and insurers are not happy to have lost access to a potential wealth of customer data in the process. To the point of deliberately sabotaging the start of the reform? “Some (…) do not recognize the new grouping codes, making it difficult, even blocking care agreements,” points out Stéphanie Dangre.

As a result, the pending files pile up with opticians, who cannot bill them. “Some opticians find themselves in a complicated situation, facing cash flow problems,” confirms Olivier Padieu. Las, an actor in the optics sector bitterly notes that “opticians are paying the costs of a conflict between complementary health insurance and public authorities over data sharing”. Consumers are not to be outdone: they cannot benefit from third-party payment because of these failures … So the whole spirit of the measure, which was part of Emmanuel Macron's electoral promises, is being undermined if this status quo remains.

During a reform monitoring committee with a view to this, on February 4 at the Ministry of Health, the subject of these technical bugs was raised. “All of the participants stressed that these difficulties are on the way to being resolved and reaffirm their willingness to work together to raise the last remaining ones,” said the Social Security Department, after this meeting. . “A constructive meeting to find solutions together”, soberly commented on Twitter, the director general of the National Federation of French Mutuality, Albert Lautman.

The ministry is however determined to keep up the pressure on all stakeholders with a view to rapid deployment of third-party payment on the 100% health offer: “The completion of this project will be subject to very regular monitoring.”

* Methodology: Online survey carried out from 24 to 31 January 2020 with 1,098 Internet users who have carried out a comparison in health insurance on Assurland.com for 2 years.

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