What impact can be expected from the generalization of company supplementary health insurance on the rate of non-coverage in France? A simulation based on the 2012 Health and Social Protection survey.

Summary In France, despite the preponderant role of compulsory health insurance in the financing of health care expenses (75.9% on average in 2012), access to health care is strongly dependent on the possession of a complementary health insurance contract, and its quality, of which 5% of the population remained without in 2012. The generalization of access to supplementary health insurance is thus at the heart of the national health strategy set out in 2013 by Marisol Touraine and the first measure negotiated in the framework of the National Interprofessional Agreement (ANI) of January 2013 will consist in generalizing company supplementary health insurance and improving its portability on January 1, 2016. This article proposes to study the expected effects of this measure on the generalization of complementary health insurance in France and its consequences in terms of well-being on the one hand, and on inequalities in access to complementary health insurance on the other. Using the 2012 Health and Social Protection Survey, we simulate the impact of the introduction of the ANI on the proportion of individuals who remain uncovered by a complementary health insurance plan in the general population and according to health status, socio-economic status, time and risk preferences and the reason for not having coverage. We show that the rate of non-coverage, estimated at 4% after the generalization of company supplementary health insurance and at 3.7% taking into account portability, will always remain higher for the most vulnerable populations, and in particular the unemployed. On the other hand, the ANI will reduce the link, all other things being equal, between non-coverage and preferences with regard to time and risk. This measure therefore risks countering non-coverage by choice without eliminating non-coverage for financial reasons.