Proposals for reforming public and private health insurance
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France: HCAAM proposals for reforming public and private health insurance


At the request of health minister Olivier Véran, the High Council for the future of health insurance (Haut Conseil pour l’avenir de l’assurance maladie, HCAAM) has published a report examining the opportunities for reforming the relationship between public and private health insurance.

The report looks at four possible scenarios including most notably the creation of a “grande Sécu” covering all essential care. In this scenario, all current co-payments (eg those levied on medicines) and patient charges incurred in the statutory system would be abolished. For medicines and medical devices, as well as dental and optical care, a basket of care would be defined which would be fully (ie 100%) reimbursed by the statutory system. Complementary (private) insurers would just provide cover for care outside of this basket.

Three other scenarios are also put forward, namely:

  • Making only minor changes to the existing health insurance system including abolishing certain exemptions from compulsory complementary health insurance (eg those employed part-time) and making it easier for certain groups to subscribe to complementary health insurance (eg the self-employed)
  • making complementary health insurance mandatory for everyone
  • establishing two separate baskets of care which would be reimbursed by statutory and complementary insurers, respectively. Under this scenario, responsibility for covering some elements of care would be transferred from the public to the private sector. Notably, medicines currently reimbursed at 15% and 30% would no longer be covered by statutory insurance.


  1., “”Grande Sécu”: 5 minutes pour tout comprendre”, 19th January 2022
  2., “Rapport du HCAAM- Quatre scénarios polaires d’évolution de l’articulation entre sécurité sociale et assurance maladie complémentaire”, 14th January 2022

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