comptes nationaux de la santé 2010 · 2019-10-08 · jonathan duval, rémi lardellier et renaud...
TRANSCRIPT
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CONSEIL D’ORIENTATION DES RETRAITES Séance plénière du 14 octobre 2015 à 9 h 30 « Le pouvoir d’achat des retraités »
Document N°10 Document de travail,
n’engage pas le Conseil
La redistribution opérée par l’assurance maladie obligatoire et par les assurances complémentaires selon l’âge
Jonathan DUVAL, Rémi LARDELLIER et Renaud LEGAL, DREES « Comptes nationaux de la santé 2010 », document de travail n°161, DREES,
septembre 2011
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La redistribution opérée par l’assurance maladie obligatoire et par les assurances complémentaires
selon l’âge
Jonathan DUVAL (DREES) Rémi LARDELLIER (DREES)
Renaud LEGAL (DREES)
Cette étude présente pour l’année 2008 la redistribution opérée par les systèmes
d’assurance maladie obligatoire et complémentaire entre les classes d’âge.
Les mécanismes de financement de l’assurance maladie obligatoire répondent à deux
principes : la solidarité des bien portants vis-à-vis des malades et l’accessibilité des soins à
tous, quelle que soit leur capacité financière. Ainsi, alors que les remboursements des soins
de l’assurance maladie obligatoire dépendent du risque maladie, son financement est lié aux
revenus, via notamment les cotisations et les contributions sociales. Du respect de ces
principes découlent des transferts intergénérationnels importants, des actifs vers les
retraités. Le risque maladie augmentant avec l’âge, ce sont en effet les retraités qui ont les
dépenses moyennes de soins les plus élevées alors que leurs contributions sont plus faibles.
L’assurance maladie complémentaire intervient quant à elle pour financer les dépenses non
remboursées par l’assurance maladie obligatoire. Dans un environnement concurrentiel mais
régulé, sa tarification ne dépend pas directement de l’état de santé, mais est croissante avec
l’âge. Ainsi, en comparaison des transferts induits par l’assurance maladie obligatoire, les
transferts entre classes d’âge opérés par l’assurance maladie complémentaire apparaissent
limités.
Ces transferts entre classes d’âge ne doivent toutefois pas masquer la dispersion importante
des dépenses de santé au sein de chaque classe d’âge. À chaque âge une partie des
individus bénéficie de remboursements des assurances maladies obligatoire et
complémentaire supérieurs aux cotisations versées. Il n’en demeure pas moins que ces
personnes, en mauvaise santé, doivent assumer des restes à charge supérieurs en
moyenne à ceux des autres assurés.
graph1-partie3
Graphique 1 - Répartition de la population métropolitaine selon la tranche d'âge en 2008
Tranche d'âgePart dans la population métropolitaine
Jusqu'à 5 ans7.4%
De 6 à 15 ans12.1%
De 16 à 25 ans12.6%
De 26 à 35 ans12.7%
De 36 à 45 ans14.1%
De 46 à 55 ans13.5%
De 56 à 65 ans11.9%
De 66 à 75 ans7.8%
Plus de 75 ans8.0%
Source : Insee, estimations de population.
Champ : France métropolitaine, territoire au 31 décembre 2008.
Note de lecture : au 31 décembre 2008, la part des individus de plus de 75 ans était estimée à 8 % de la population métropolitaine
prahp2-partie3
Graphique 2 - Dépenses de santé en fonction de l'âge : moyennes et indicateurs de dispersion
MédianeMoyenneP90
Jusqu'à 5 ans39011301420
De 6 à 15 ans3009501420
De 16 à 25 ans2909301630
De 26 à 35 ans43016403740
De 36 à 45 ans56020603570
De 46 à 55 ans85019904000
De 56 à 65 ans134026905440
De 66 à 75 ans1930480010160
Plus de 75 ans2530660017540
Source : Ines-Omar 2008.
Champ : dépenses présentées au remboursement de l’assurance maladie.
Note de lecture : Les dépenses annuelles de santé d’une personne âgée de plus de 75 ans s’élèvent en moyenne à 6 600 €. La dispersion des dépenses de santé des personnes âgées est bien plus importante que celle des classes d’âge plus jeunes.
graph3-partie3
Graphique 3 - Remboursements annuels moyens par les assurances obligatoire et complémentaire
Remboursements complémentairesRemboursements de l'Assurance maladie
Jusqu'à 5 ans210 €910 €
De 6 à 15 ans210 €710 €
De 16 à 25 ans170 €720 €
De 26 à 35 ans260 €1,310 €
De 36 à 45 ans310 €1,630 €
De 46 à 55 ans370 €1,460 €
De 56 à 65 ans450 €2,010 €
De 66 à 75 ans510 €4,030 €
Plus de 75 ans630 €5,740 €
Source : Ines-Omar 2008.
Champ : dépenses présentées au remboursement de l’assurance maladie ; pour les remboursements complémentaires, la population comprend les seuls individus bénéficiant d’une couverture maladie complémentaire.
Note de lecture : un individu âgé de moins de six ans obtient, en moyenne et sur un an, un remboursement de 910 € de la part de l’assurance maladie. Si en plus il bénéficie d’une couverture maladie complémentaire, alors celle-ci lui permet d’obtenir en moyenne 210 € supplémentaires.
graph4-partie3
Graphique 4 - Indice et montant des restes-à-charge moyens après intervention de la couverture maladie complémentaire
Indice du reste-à-charge moyen après AMCà titre indicatif
Jusqu'à 5 ans2520 €
De 6 à 15 ans6350 €
De 16 à 25 ans6350 €
De 26 à 35 ans10080 €
De 36 à 45 ans175140 €
De 46 à 55 ans213170 €
De 56 à 65 ans300240 €
De 66 à 75 ans337.5270 €
Plus de 75 ans312.5250 €
Sources : Ines-Omar 2008.
Champ : dépenses présentées au remboursement de l’assurance maladie ; individus couverts par une assurance maladie complémentaire.
Note de lecture : le reste-à-charge final augmente de 213 % (indice 313) entre les classes d’âge « 26-35 ans » (base 100) et « plus de 75 ans » ;une fois obtenus les remboursements de l’assurance maladie et des assurances complémentaires, un individu âgé de plus de soixante-quinze ans paie en moyenne et sur un an 250 €.
graph5-partie3
Graphique 5 - Montant moyen de contributions et de cotisations sociales affectées à la branche maladie par tranche d’âge
tranche d'âgeCSG activité et remplacementCSG patrimoinecotisations sociales patronales et des indépendantstotal
jusqu'à 5 ans0000
de 6 à 15 ans0000
de 16 à 25 ans2231281505
de 26 à 35 ans10252417102759
de 36 à 45 ans12998922693657
de 46 à 55 ans144015124504041
de 56 à 65 ans113319313632689
de 66 à 75 ans6861841451015
Plus de 75 ans56018260802
Source : Ines-Omar 2008.
Champ : ensemble des individus dans des ménages ordinaires métropolitains.
Note de lecture : Un individu âgé de 46 à 55 ans participe en moyenne à hauteur de 4 041 € par an au financement de la branche maladie dont 1 440 € de CSG activité et remplacement, 151€ de CSG patrimoine et 2 450 € de cotisations patronales et des indépendants.
graph6-partie3
Graphique 6 : Contribution moyenne au financement rapportée aux remboursements moyens, pour l'AMO et l'AMC
Graphique 6 - Contribution moyenne au financement rapportée aux remboursements moyens, pour l'AMO et l'AMC
Rapport AMOMoyenneRapport AMCMoyenne
Jusqu'à 5 ans0%104%76%126%
De 6 à 15 ans0%104%76%126%
De 16 à 25 ans71%104%135%126%
De 26 à 35 ans211%104%165%126%
De 36 à 45 ans225%104%148%126%
De 46 à 55 ans277%104%132%126%
De 56 à 65 ans134%104%127%126%
De 66 à 75 ans25%104%125%126%
Plus de 75 ans14%104%110%126%
Source : Ines-Omar 2008.
Champ : Pour l’AMO, ensemble de la population. Pour l’AMC, tout individu bénéficiant d’une couverture maladie complémentaire. L’individualisation des primes se fait ici selon l’hypothèse 2 qui n’attribue pas de cotisations aux ayants-droits des contrats collectifs (cf. supra). Hors recettes indivisibles et frais de gestion (cf. note de bas de page, n°9, page 40).
Note de lecture : un individu âgé de 46 à 55 ans contribue en moyenne à hauteur de 277 % aux remboursements moyens versés par l’assurance maladie à chaque membre de sa classe d’âge.Pour la même classe d’âge, un individu couvert par une assurance maladie complémentaire contribueà celle-ci en moyenne à hauteur de 132 % aux remboursements moyens qu’elle lui verse. Pour l’ensemble des personnes concernées les taux moyens s’établissent à 104 % pour l’AMO et 126 % pour l’AMC.
graph7-partie3
Graphique 7 - Solde 'Remboursements moyens - contributions moyennes' pour l'AMO et l'AMC
Solde AMCSolde AMO
Jusqu'à 5 ans70 €910 €
De 6 à 15 ans60 €710 €
De 16 à 25 ans-30 €210 €
De 26 à 35 ans-140 €-1,450 €
De 36 à 45 ans-120 €-2,030 €
De 46 à 55 ans-80 €-2,580 €
De 56 à 65 ans-90 €-680 €
De 66 à 75 ans-120 €3,020 €
Plus de 75 ans-60 €4,940 €
Source : Ines-Omar 2008.
Champ : Pour l’AMO, ensemble de la population. Pour l’AMC, tout individu bénéficiant d’une couverturemaladie complémentaire. L’individualisation des primes se fait ici selon l’hypothèse 2 qui n’attribue pasde cotisations aux ayants-droits des contrats collectifs (cf. supra). Hors recettes indivisibles et frais de gestion (cf. note de bas de page, n°9, page 40.
Note de lecture : un individu de 6 ans, pris en charge par un organisme de couverture maladie complémentaire, reçoit de la part de celui-ci en moyenne 60 € de plus que les primes moyennes qu’il verse. Pour ce même individu, le solde AMO s’élève en moyenne à 710 €.
graph8-partie3
Graphique 8 - Taux d'individus en ALD par classe d'âge
classe d'âgetaux d'individus qui n'ont pas de dépenses de santétaux d'individus en ALD
jusqu'à 5 ans3%2%
de 6 à 15 ans8%3%
de 16 à 25 ans16%3%
de 26 à 35 ans10%5%
de 36 à 45 ans9%7%
de 46 à 55 ans9%14%
de 56 à 65 ans5%24%
de 66 à 75 ans3%38%
plus de 75 ans2%50%
Source : Ines-Omar 2008.
Champ : ensemble des individus dans des ménages ordinaires métropolitains.
Note de lecture : 3 % des individus de 6 à 15 ans sont en ALD.
8 % des individus de 6 à 15 ans n’ont pas de dépenses de santé dans l’année.
graph9-partie3
Graphique 9 : Courbe de concentration de la consommation totale de soins par tranche d'âge
concentration des dépenses dans la classe d'âge des 26 à 35 ansconcentration des dépenses dans la classe d'âge des plus de 75 ansconcentration des dépenses dans la classe d'âge des moins des 6 à 15 ans
poids cumulésdépenses cumuléespoids cumulésdépenses cumuléespoids cumulésdépenses cumulées
0.000021845400.000118292700.000054831300.5
0.000045228300.000211221600.000098965100.5
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0.000120181600.000328491700.000279671100.5
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0.00121084900.001864349900.001237226500.5
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0.002205300200.003009749400.001832145500.5
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0.002415466200.003203847200.001936669100.5
0.002504189700.00330390900.002033988900.5
0.002570696700.003390662800.002118234200.5
0.002634793500.003491868900.002147608500.5
0.002678308400.003549780700.002192221700.5
0.002791238900.003618148400.00222915300.5
0.002818178600.003684989200.002296397400.5
0.002843888900.003774015900.002371530700.5
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