cochon dentaire

Orthodontics: health insurance plans to cover fees

The Board of Directors of the National Health Insurance Fund (Cnam) presented on July 13 its report “Expenditure and Income 2023” which makes it possible every year to formulate “concrete proposals for savings to meet the objectives of insurance expenditures and thus ensure the maintenance of a unified, efficient and sustainable health system”.

Among the 30 proposals chosen to highlight discussions about the future PLFSS Financing Bill, the Canadian Council supports action “that should be taken to reduce high-cost household residuals” if orthodontic care is to be undertaken.

1.3 billion euros still to be paid in 2021

In 2021, according to the report, expenditures related to orthodontics account for 1.9 billion euros, of which 1.3 billion remains to be paid, financed by the families themselves with up to 424 million euros (ie 23% of spending) and supplementary insurance. up to 44% of the total. Compulsory health insurance pays just under 30% of orthodontic expenses.

Based on an average price of €728 per semester (excluding C2S), the average remaining fee per household is estimated at €167 per semester. Cnam notes that this tariff has “increased by 10%” since 2013 and indicates a “significant heterogeneity in tariff practice” across the territory.

Towards a complete overhaul of the labels?

In order to reduce the rest borne by families, the health insurance proposes to integrate orthodontic treatments into the dental health basket at 100%, which means “first of all” can we read in the report, to determine the limits of the billing fees “is currently the case for remedial measures In baskets that are 100% healthy and kept at a moderate cost.”

Cnam stresses that this integration – likely to result in an “increase in use and therefore in expenditures related to these treatments – cannot be “conceived without an in-depth, joint analysis of the situation”, in consultation with health professionals and complementary organizations.

“It may be appropriate to link the development of care to terminology reform in order to differentiate, for example, dysmorphic treatments according to severity or even class number of treatment,” she adds.

‘Sustainable’ growth in orthopedic treatments

The Expense & Products report provides valuable data on the performance breakdown of orthodontic treatments. health centers. »

The momentum of this care has continued since 2013 (+4.3% per year) and the rate of recourse to orthodontics has increased in parallel in recent years (20% in 2021 vs. 16% in 2013).

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