More details on Macron ‘zero charge’ healthcare plan

The new plans will seek to dramatically reduce the cost to patients of hearing aids, glasses, and dental work

More information has been revealed on France’s new “zero extra charge” healthcare reform, which is set to come into force from 2019, and is being discussed in more detail this week in the Assemblée.

The plan is a key policy from President Emmanuel Macron, who promised to deliver it during his presidential electoral campaign.

It is set to dramatically reduce the cost to patients of glasses, dental prostheses and hearing aids, and will impose a strict ceiling on the payable fees.

MPs will discuss the scheme this week, as part of the Securité Sociale budget plans for 2019.

Glasses, dental sets and hearing aids have all been highlighted because studies show they tend to be one of the first healthcare items people give up when faced with rising costs.

A poll from audiovisual council the CSA for consumer credit group Cofidis found that in the past 12 months, one in three French people has given up on dental and optical care due to cost.

Similarly, these areas have been deemed as relatively straightforward to fix.

Providers will need to offer a selection of frames (Pixnio / CC0 Public Domain)

Under the new system, the cost of glasses frames will be capped at €30, with each provider required to offer 17 frame choices for adults, and 10 for children, in two colours.

The maximum cost for lenses will depend on the strength of your eye prescription. For example, lenses for “moderate” myopia (between -2 and -4), will be capped at €75 for both, with lenses that are anti-reflection, hardened, and thinned.

In this case, the cost of the glasses would be €105 in total, with the entire amount paid for by the State and the patient’s own medical insurance plan.

Patients will be able to choose more expensive frames if they wish, but the amount paid for by insurers will be capped at €100, to enable providers to focus more on lenses.

For dental prostheses, the zero charge plan will apply only to ceramic fillings for visible teeth, and metal for non-visible teeth. In total, 45% of fillings, bridges and crowns will be paid for 100%.

For hearing aids, the plan will apply to all models, offering 12 different settings, and a yearly checkup. The maximum amount permitted will be €950 per ear, every four years. Patients will also be permitted to opt for high-end models and pay extra themselves, if they wish.

Marie-Annick Lambert, from patient association France Assos Santé, said: “We are satisfied because this is focused on problems that can really affect your daily life. Bad vision, bad teeth - these are “concrete” things. For once, there is going to be a viable level of cost.”

Yet, some have criticised the plans, saying they risk reducing the quality of prostheses, as well as risking the closure of some clinics.

Some clinics have said that focusing on the cost of glasses frames means that French-made models could be undercut by pieces “Made in China”. French frames typically cost €30 wholesale, compared to just €10 for Chinese-made models.

Similarly, dentists fear that the plans could also reduce the quality of dental prostheses, and drive down the standards of the ceramic material used for fillings and other work.

Lionel Marslen, president of the dental work group La Fédération des Prothésistes Artisans du Dentaire, has said: “We are faced with the problems of having to offer a maximum number of prostheses, to the detriment of quality.”

Ear doctors have also questioned the plans, saying that they could be “financially untenable in the short term”, according to a recent study, and could see “a significant drop in the net result” of audio centres. One in six sites could be at risk of closure in the next five years, the study said.

Healthcare insurers have also warned that the scheme could drive up prices for everyone. The average price rise for insurance (your “mutuelle”) could be as much as 6-9% within three years, depending on the scheme, according to a study from healthcare council Santiane.

Ms Lambert, from France Assos Santé, said: “Past experience shows that the risk of a significant rise [in cost] does exist, and we could see a hike in the next three years. If the rise in insurance costs is too much, older people will simply give up their insurance, so the new plan won’t apply. It will then be a reform for nothing.”

But government spokesperson Benjamin Griveaux has said: “Insurers are urged to not increase their prices, and I invite them to respect the measures taken by the State.”

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