Private Health Insurance in France: Between Europeanization and Collectivization.
Policy PointsPrivate health insurance (PHI) in France has been facing critical changes over the past 30 years. A complementary and voluntary scheme, it has been historically dominated by nonprofit entities. However, the share of for‐profit insurance companies in the sector has significantly increase...
| Publicado en: | Milbank Quarterly Vol. 97; no. 4; pp. 1108 - 1151 |
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| Autores principales: | , |
| Formato: | Artículo |
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Wiley-Blackwell
Dec2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=140269906&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 140269906 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0887378X MIQ jtl: Milbank Quarterly issn: 0887378X maglogo: Y pubinfo: dt: Dec2019 vid: 97 iid: 4 pid: 480 pub: Wiley-Blackwell artinfo: ui: 140269906 10.1111/1468-0009.12420 ppf: 1108 ppct: 43 formats: tig: atl: Private Health Insurance in France: Between Europeanization and Collectivization. aug: au: BENOÎT, CYRIL CORON, GAËL affil: Centre d'études européennes et de politique comparée (CEE), Sciences Po, Centre National de la Recherche Scientifique (CNRS) Institut de l'Ouest Droit et Europe & Ecole des Hautes Etudes en Santé Publique su: France European Union Health insurance Insurance Interviewing Health policy Newspapers Policy sciences Private sector Government regulation Economic competition Conceptual structures Government publications Insurance companies Research methodology Research funding Descriptive statistics Health insurance exchanges Stakeholder analysis sug: subj: Health insurance Insurance Interviewing Health policy Newspapers Policy sciences Private sector Government regulation Economic competition France European Union Other Insurance Funds All Other Insurance Related Activities Third Party Administration of Insurance and Pension Funds Direct Health and Medical Insurance Carriers Other Direct Insurance (except Life, Health, and Medical) Carriers Insurance Agencies and Brokerages Direct group life, health and medical insurance carriers Direct individual life, health and medical insurance carriers Administration of Public Health Programs Newspaper Publishers Book stores and news dealers News Dealers and Newsstands Book, periodical and newspaper merchant wholesalers Book, Periodical, and Newspaper Merchant Wholesalers Conceptual structures Government publications Insurance companies Research methodology Research funding Descriptive statistics Health insurance exchanges Stakeholder analysis keyword: Europeanization health insurance health policy regulation Europeanization health insurance health policy regulation ab: Policy PointsPrivate health insurance (PHI) in France has been facing critical changes over the past 30 years. A complementary and voluntary scheme, it has been historically dominated by nonprofit entities. However, the share of for‐profit insurance companies in the sector has significantly increased. Nonprofit firms also changed their strategies and mimicked some for‐profit behaviors.The present paper argues that this process is a result of the conflict‐provoking coevolution of the insurance and health care sectors. Trying to improve the regulation of the insurance industry as whole, two European directives first jeopardized the business model of nonprofit entities. Then, two national reforms designed to improve health coverage significantly increased competition among insurers, notably in the area of corporate‐level contracts.Decoupling the insurance and health care sectors has become a major source of policy feedback and unexpected outcomes of reforms affecting the very organization of PHI. Context: In France, private health insurance (PHI) has an exceptionally high level of coverage and accounts for 13.7% of health expenditures. A complementary and voluntary scheme, it has been historically dominated by nonprofit, mutual benefit societies. Over the past 20 years, however, the market share of for‐profit insurance companies has increased by 47%. Financialization of the field developed, and competition based on new risk management strategies also increased. The broad aim of this paper is to characterize and to elucidate the causes of this trend. More specifically, we are interested in how and to what extent a series of supranational and national policies contributed to this situation. Method: Our data come from three sources. We first reviewed documents published by health insurers, government reports, and newspaper articles. We then conducted two semistructured interview campaigns between September 2017 and May 2018. The first mostly covered private and public actors and their involvement in European Union (EU) policymaking (n = 21). The second series of interviews was conducted with another group of actors directly involved at the French level (n = 16). Findings: Our findings support preliminary observations. PHI in France, we argue, is indeed facing a development of competition and marketlike instruments. Four major policies (two EU directives and two national reforms) played a significant role in this outcome. Surprisingly, however, it has never been the purpose of legislators and policymakers: while EU directives created a regulatory framework for insurance activities within the Single Market, policies adopted at the national level initially aimed at improving health coverage. We show that it is the interactions and the noncoordination among all of these policies that explain their unexpected outcome. Conclusions: The trend described in this paper is twofold. The first is Europeanization, as PHI in France is increasingly affected by EU legislation. Since this framework tends to favor larger firms and for‐profit companies, a reduction in statutory coverage can no longer be considered a quasi‐neutral transfer from (publicly owned) social security to nonprofit providers. At the same time, PHI is shifting toward collectivization: as competition increases, complementary health coverage is becoming gradually standardized and based at the corporate level. Together, these changes are likely to reduce freedom of choice and individual welfare, an assumption supported by studies published on the most recent period. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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