Crise et déficit de l'assurance maladie. Faut-il changer de paradigme ?

The deficit of health insurance, about 1 percentage point of GDP mainly results from the economic crisis which reduced social contributions. This deficit contributes to the automatic stabilization of the economy and it should disappear with the return of growth. As far as it is not returned, the voluntary reduction of the deficit, rising levies or lower spending, would be counter-cyclical and must be rejected. But part of the deficit, we evaluate between 0.35 and 0.7 percent of GDP, results from the existence of a structural gap between growth in health spending and growth in GDP. For a good long-term management of health insurance, it is necessary eliminate the structural deficit, evaluated between 1.4 and 2.8 percent of GDP in 2020 without structural evolution. Hitherto it has been contend by a combination of taxes increase and reduction of reimbursement rate. The search for a better control of expenditure founded on a change in the organization of care (more collective exercise promoting complementary medicine and alternative between professions, building of a new system integrating best the ambulatory and hospital, ...) and a reform of the modes of financing (with more per capita remuneration for the physicists) for reduce inequalities in access to care would be worth discussed in the context of discussions on the spending trend health and their financing. JEL Classification codes: I18, H12, H51, H68