Finalised projects

Universite de bordeaux

Social Security and Complementary Health Insurance: Towards a Coherent Version of the French Healthcare System//




Nouvelle Aquitaine Region

Project's holder:

Eri Kasagi


5 years - January 2017 - December 2021


The ultimate goal of this project is to propose a coherent vision of the French healthcare system, which comprises compulsory health insurance coverage and private health insurance coverage (complementary health insurance), with two main aims. The first is to find solutions for making the two-tier French system more equal, fair and efficient, while the second is to foster innovations in the field of complementary health insurance to improve how the system works overall. The project consists of two portions. The first portion is theoretical and legal and involves analysing and understanding legal regulations concerning private health insurance contracts and thinking about fundamental questions. A number of key questions will be considered such as, “How can a line be drawn between compulsory health insurance and complementary health insurance (or additional complementary health insurance if this exists) in legal terms? Who should decide where this line is drawn, and according to what sort of procedure, given the degree of importance and variety of stakeholders? What sort of legal system could offset the tendency to push back this line, or reduce compulsory health insurance coverage in light of financial and budgetary pressure to reduce public health deficits? What precise role should we expect each of these types of coverage to play in terms of ensuring access to healthcare? To what extent should inequality in complementary health insurance be considered justifiable or legitimate and according to what reasoning? How can this be decided? In this first portion of the project, the methodology of comparative law will allow us to examine the French system from the perspective of the Canadian and Japanese systems. Our findings will in turn inform our consideration of the solutions to these key questions.
The second portion is empirical and interdisciplinary and involves analysing complementary health insurance contracts offered on the market, both today and in the past. What risks do the contracts cover? What options and services are associated with or included in these contracts? How is risk selection carried out (according to the legal regulations that we have identified)? How are the premium levels (contributions) established? Are these contracts designed or modified according to certain Social Security reforms? If so, according to which reforms and in what ways? This portion will be carried out in collaboration with health economists.