{"id":2707,"date":"2012-12-17T18:13:45","date_gmt":"2012-12-17T17:13:45","guid":{"rendered":"http:\/\/www.solucominsight.fr\/?p=2707"},"modified":"2020-01-02T11:00:16","modified_gmt":"2020-01-02T10:00:16","slug":"lassurance-sante-sous-les-projecteurs","status":"publish","type":"post","link":"https:\/\/www.riskinsight-wavestone.com\/en\/2012\/12\/lassurance-sante-sous-les-projecteurs\/","title":{"rendered":"L\u2019assurance sant\u00e9 sous les projecteurs"},"content":{"rendered":"

Le secteur de la sant\u00e9 (assurance sant\u00e9) vit de profondes mutations, largement relay\u00e9es par les m\u00e9dias, il suffit d\u2019observer l\u2019actualit\u00e9 de ces derni\u00e8res semaines. Des mutations qui ne sont pas pr\u00eates de cesser, bien au contraire.<\/p>\n

Une actualit\u00e9 de l’assurance sant\u00e9\u00a0<\/strong>riche\u00a0<\/strong>en \u00e9v\u00e9nements<\/strong><\/h2>\n

Le r\u00e9cent projet de loi sur les r\u00e9seaux de soins a suscit\u00e9 de nombreux d\u00e9bats \u00e0 l\u2019Assembl\u00e9e nationale. \u00c0 travers ce projet les mutuelles sant\u00e9 seraient autoris\u00e9es \u00e0 privil\u00e9gier les professionnels de sant\u00e9 qui sont membres de leur r\u00e9seau (via une majoration du niveau de remboursement par exemple).<\/p>\n

Le projet de loi de financement de la S\u00e9curit\u00e9 Sociale 2013 (le fameux \u00ab\u00a0PLFSS 2013\u00a0\u00bb) pr\u00e9voit quant \u00e0 lui l\u2019encadrement de l\u2019exercice lib\u00e9ral des m\u00e9decins \u00e0 l\u2019h\u00f4pital. Il pr\u00e9voit notamment de plafonner les d\u00e9passements d\u2019honoraires en \u00e9changes d\u2019une revalorisation des tarifs de convention des professionnels de sant\u00e9 (ce tarif servant de base pour le remboursement de la s\u00e9curit\u00e9 sociale).<\/p>\n

En plus de ces sujets souvent pol\u00e9miques qui r\u00e9-ouvrent l\u2019\u00e9ternel d\u00e9bat politique sur l\u2019acc\u00e8s aux soins, l\u2019exercice budg\u00e9taire de cette ann\u00e9e a encore mis en \u00e9vidence les difficult\u00e9s financi\u00e8res de notre r\u00e9gime de protection sociale (d\u00e9ficit de la seule branche maladie de -5,1 milliards d\u2019euros pr\u00e9vu en 2013).<\/p>\n

Dans le contexte \u00e9conomique et financier actuel, l\u2019enjeu des mois ou ann\u00e9es \u00e0 venir va donc consister \u00e0 faire \u00e9voluer fortement le mod\u00e8le \u00e9conomique de la sant\u00e9 tout en pr\u00e9servant son caract\u00e8re social pr\u00e9pond\u00e9rant.<\/p>\n

\u00a0\u2026qui pr\u00e9figurent la fin du mod\u00e8le actuel<\/h2>\n

\u00a0<\/strong>Conscient de ces enjeux, les assureurs priv\u00e9s (compagnies d\u2019assurance, mutuelles\u2026) auront \u00e0 l\u2019avenir un r\u00f4le de plus en plus important dans ce syst\u00e8me.<\/p>\n

Aujourd\u2019hui principalement cantonn\u00e9s dans un r\u00f4le de seul remboursement (ils se qualifient eux-m\u00eames de \u00ab\u00a0payeurs aveugles\u00a0\u00bb), ils sont confront\u00e9s \u00e0 une augmentation de leurs d\u00e9penses de remboursement sous l\u2019effet de deux ph\u00e9nom\u00e8nes : l\u2019augmentation continue, depuis plusieurs ann\u00e9es, de la consommation m\u00e9dicale\u00a0; le d\u00e9remboursement de certains postes m\u00e9dicaux par la s\u00e9curit\u00e9 sociale (m\u00e9dicaments notamment\u2026) qui se traduit par un transfert de la charge vers les assureurs.<\/p>\n

Cette augmentation des co\u00fbts des assureurs se traduit de mani\u00e8re m\u00e9canique par une augmentation des cotisations sant\u00e9 (en moyenne 5% d\u2019augmentation par an depuis plusieurs ann\u00e9es) alors que les assur\u00e9s et clients ne per\u00e7oivent pas forc\u00e9ment une am\u00e9lioration de la qualit\u00e9 des services\u00a0!<\/p>\n

Aujourd\u2019hui, un large consensus est partag\u00e9 par l\u2019ensemble des acteurs sur les limites de ce mod\u00e8le.<\/p>\n

\u00a0Vers un changement de mod\u00e8le des assureurs sant\u00e9<\/h2>\n

\u00a0<\/strong>Les assureurs sant\u00e9 souhaitent maintenant d\u00e9velopper des services sant\u00e9 et se positionner ainsi en fournisseur de services, bien en amont de la seule prestation de remboursement.<\/p>\n

C\u2019est notamment la logique des r\u00e9seaux de soins qui consistent \u00e0 organiser et proposer des services de qualit\u00e9 \u00e0 un co\u00fbt ma\u00eetris\u00e9.<\/p>\n

Quelques initiatives voient le jour de la part de quelques assureurs pour proposer des services sant\u00e9, mais le mouvement d\u00e9bute \u00e0 peine et reste encore tr\u00e8s timide. Dans le domaine de ces services sant\u00e9, le spectre est en effet tr\u00e8s large\u00a0: du simple conseil d\u2019orientation\u2026\u2026 \u00e0 la prise en charge compl\u00e8te des soins pour le compte du client.<\/p>\n

Les assureurs ont donc un important d\u00e9fi \u00e0 relever pour g\u00e9rer cette profonde mutation du m\u00e9tier de \u00ab\u00a0rembourseur\u00a0\u00bb \u00e0 celui de \u00ab\u00a0fournisseur\/organisateur\u00a0\u00bb de services de sant\u00e9.<\/p>\n

Cette mutation devrait s\u2019appuyer notamment\u00a0sur l\u2019utilisation intensive et tr\u00e8s large des nouvelles technologies (les objets connect\u00e9s pour \u00ab\u00a0monitorer\u00a0\u00bb la sant\u00e9 des clients, les nouvelles technologies m\u00e9dicales\u2026), sur le d\u00e9veloppement des partenariats avec des fournisseurs de services de sant\u00e9 (t\u00e9l\u00e9m\u00e9decine, di\u00e9t\u00e9ticiens\u2026). Des mutations qui vont \u00e9galement r\u00e9volutionner le marketing, avec des approches de marketing orient\u00e9es services et non plus financement, pour faire \u00e9voluer les offres. Enfin les mod\u00e8les d\u2019organisation vont eux aussi bouger, pour int\u00e9grer ces nouveaux m\u00e9tiers de fournisseurs de services.<\/p>\n

Int\u00e9gration et utilisation des nouvelles technologies, transformation des organisations, \u00e9volutions des offres\u2026 autant de nombreux chantiers \u00e0 mener d\u00e8s 2013\u00a0!<\/p>\n

<\/p>\n

 <\/p>\n

Retrouvez tous nos articles sur le secteur de l\u2019assurance sur\u00a0Insurance speaker<\/a>, le blog assurance des consultants Solucom<\/p>\n","protected":false},"excerpt":{"rendered":"

Le secteur de la sant\u00e9 (assurance sant\u00e9) vit de profondes mutations, largement relay\u00e9es par les m\u00e9dias, il suffit d\u2019observer l\u2019actualit\u00e9 de ces derni\u00e8res semaines. Des mutations qui ne sont pas pr\u00eates de cesser, bien au contraire. Une actualit\u00e9 de l’assurance…<\/p>\n","protected":false},"author":86,"featured_media":2613,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"page-templates\/tmpl-one.php","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[38,32],"tags":[756,759,758,757,760],"coauthors":[912],"class_list":["post-2707","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assurance","category-marketing-relation-client","tag-assurance-sante","tag-assureurs-sante","tag-plfss","tag-securite-sociale","tag-services-sante"],"acf":[],"yoast_head":"\nL\u2019assurance sant\u00e9 sous les projecteurs<\/title>\n<meta name=\"description\" content=\"Le secteur de la sant\u00e9 (assurance sant\u00e9) vit de profondes mutations, largement relay\u00e9es par les m\u00e9dias, il suffit d\u2019observer l\u2019actualit\u00e9 de ces derni\u00e8res semaines. 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