Question 10668 — maternity health insurance

Summary

Mrs. Sira Sylla draws the attention of the Minister of Solidarity and Health to the reform of the zero-charge balance in the optical sector. As recalled by the Government and the President of the Republic more specifically during the 42nd Congress of the Mutuality in mid-June 2018, the field of health is one of the key priorities of the 2017-2022 five-year term. The MP was contacted on this subject by the opticians of her constituency worried about seeing their medical field suffer a drop in subsidies due to the reduction in reimbursement of optical costs by mutual health insurance companies. As it currently stands, the remainder basket at zero charge would represent around 20% of eyeglass purchases. In comparison with the rest at zero charge for hearing aids - i.e. 65% of volumes - or dental care - 46% -, the optical basket is not not high enough. The rest of the market, i.e. 80% of glasses sales, would therefore be at free prices. In addition, the zero-charge reform provides for the coverage of visual equipment only under the ceiling of five tenths of visual acuity. Above this, support would no longer be effective because the need for visual equipment would fall within the realm of aesthetics. A change of pair of glasses will thus only be possible every three years in the case of an aesthetic consideration, while under prescription and below a visual acuity of five tenths, reimbursement may be effective every year. However, this axis of the reform involves two major risks according to the opticians met by the MP who would like to know the opinion of the Minister: the loss of income for opticians and a drop in purchasing power in this sector; the import of materials linked to the creation of pairs of glasses in countries offering low-cost production offers. These two consequences of the reform could lead to a long-term loss of the number of professionals in this sector. The MP would therefore like to know the solutions provided by the studies and consultations of the Ministry of Health with professionals with a view to responding to the pitfalls perpetrated by the loss of income for opticians. The regulatory path announced in May 2018 to legislate on this reform raises fears of a lack of discussion within Parliament. She would like it to reassure and enlighten patients, opticians and parliamentarians on the state of the discussion. Also, with regard to the zero offer, the more it is important and the free offer poorly reimbursed, the more patients will move to the free basket. Health insurance could thus go from a coverage rate of 4% of the price of visual equipment to 10 to 15% as part of the zero-cost remainder. At the same time, it would only reimburse a few cents, therefore a tiny part of the price of the equipment at a free rate. As for complementary products, their reimbursement ceilings would drop by 30% on this class of products. So, she would like know the progress of the work since technical exchanges with professionals in the optical sector began in November 2017 and since it announced on January 23, 2018 a consultation phase on the reform of the zero-charge remainder.

Machine translation from French. The official text remains authoritative.

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