Emmanuel Macron, as a candidate in the French presidential election, announced very clearly that by 2022, optical appliances would be covered 100%. Sure, but by whom? The promised reduction of the patient’s co-payment to nil, has a cost: €1.5bn. Putting an extra burden on insureds is out of the question! There are just three sources of funding or potential cost savings that come into question: Social Security (SS), the complementary (second tier) healthcare insurance providers and manufacturers or distributors of ophthalmic appliances.
Efforts expected from complementary insurers
When talking about refunds for optical expenses, the spotlight turns immediately onto complementary healthcare plans. Quite obviously, since Social Security appears to be disinterested. While the average price of single-vision glasses is almost €300, coverage by SS healthcare is capped at under €10. Group complementary healthcare plans come much more into play by covering most of the cost, taking total coverage up to between 75 and 90% of the costs incurred.
A hot potato for the manufacturers of optical appliances
Thierry Beaudet, chairman of the main association of healthcare mutuals – Mutualité Française – suggests taking a look at the manufacturing and distribution side. Baudet favors a 15% reduction in the prices of optical, dental and audio appliances saying this could potentially save €2.7bn a year.
Several studies on the price of glasses back up this claim. The optical appliance market is free. The only regulator is the customer, often unable to compare prices, and lost in the abundance of complex offerings. In reality, it is the optician who controls pricing. Offering 100% coverage in these market conditions could have undesirable inflationary effects.
What is the solution for more clarity on the optical market?
The time does not seem right for price regulation. The solution for achieving optimum coverage of these appliances would seem to be better information for insureds and customers, greater transparency on prices and insurance reimbursements and, over time, greater competition. First step: make insurance coverage for optical appliances more understandable and comparable. This is what was meant by the three “standard policies” put forward during the campaign by the candidate Macron. A prerequisite for these plans is the definition of a “basket of covers” which, logically, should be accompanied by changes in the services offered by opticians, and probably a simplification of the classification used by Social Security for ophthalmic lenses.
This indispensable consultation between distributors and payers has already taken place with the creation of care networks, which can reduce costs and improve reimbursements. An example to be followed. Complementary healthcare “standard policies” could increase the visibility, amongst opticians, of an offering branded “zero copay,” corresponding to the three levels of cover. This would be a revolution in the field of communication since such presentations, today, convey little meaning and are rarely used.
In reality, there is nothing new in all this. At the moment, the French can purchase glasses, with frames and single vision lenses for as little as thirty Euros. The challenge would be to make sure that controlled tariffs apply also to the more complex lenses and a sufficient choice of frames. Those people who prefer branded frames could lose out in this supply-side reorganization. Although the role of complementary insurance providers is to solve their insureds’ eyesight problems, it is certainly not their business to finance fashion accessories for them.
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Source information: April 2013 study by the consumer organisation UFC Que Choisir