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France's "long-term ailments" system: increased costs anticipated

France's full coverage for "long-term ailments" is not just another budget item, to be cut by any means possible.

France's system of "long-term ailments" (in French "Affections de longue durée" or "ALD") was set up at the same time as the country’s national health insurance system to ensure access to care for patients suffering from chronic and costly ailments.

Some 9 million people benefit from France's ALD system, which covers nearly 400 illnesses divided into 30 groups (the "ALD 30").

Originally, the national health insurance system reimbursed 100% of all treatment costs for ALD patients, but the level of cover is increasingly being eroded; in 2009 in France, some half a million people with qualifying long-term ailments were left with out-of-pocket treatment expenses of 1500 euros or more.

Most ALDs involve cardiovascular diseases, cancer, diabetes or psychiatric ailments.

Spending on ALDs, mainly in hospitals, accounts for two thirds of the national health insurance system’s costs. But providing 100% coverage translates into just 10% additional expenditure for the national health insurance system, over and above the cost of reimbursing the expenditures of ALD patients.

The ALD costs are set to rise further given the ageing population and the rising cost of treatments, which do not always offer an improvement for patients.

The ALD system is sometimes called into question because of its high cost. That is to forget that behind this label are 9 million of the most seriously ill members of society, and that they already bear extensive health costs not covered by insurance. This issue can only be dealt with effectively and fairly by examining the effectiveness of treatments and with no reticence with regard to the level of public spending necessary to guarantee the best level of health for all.

©Prescrire April 2010

Source: "Affections de longue durée en France : un dispositif à améliorer" Rev Prescrire 2010; 30 (317): 214-221.