HEALTH INSURANCE. The member of State Council interrogates Pierre-Marcel Revaz about selection of risks.

In a letter copy of which he sent to "Le Temps", the member of State Council calls to the boss of Groupe Mutuel: "what is a good customer in health insurance? Is it a person struck by chronic disease a part of bad customers in whom you are not interested first and foremost?" And finally: where are supposed to address " the persons who have the adversity of credit note of the serious and expensive illnesses? "

And especially, Pierre-Yves Maillard interrogates the director of Groupe Mutuel about the methods which he uses to privilege the " good customers " by asking him to be determined on a series of practices noticed by his services: Absence of answer to the demands of membership, sending of an offer concerning another box of the group, more expensive than that chosen by the applicant, the adaptation of commissions for the brokers according to the concluded contracts, the administrative delays, the losses of files, ceaseless demands of further informations...

"These practices, explains Pierre-Yves Maillard, rerelease complaints which arrive at our services. They concern various insurers, among which those who are affiliated to Groupe Mutuel but not only theirs. These complaints indicate the existence of problematic behavior, but they have naturally no statistical value. My purpose thus was not to denounce specific practices of Groupe Mutuel but to react to an assertion which seems to me inacceptable. The law says that health insurers have to accept all the customers. This thus excludes as a rule the selection of risk. " 

The law that, we assert at Groupe Mutuel's, is respected. But we shall not know about it more: "Within the framework of the relations which we maintain with our partners in the Health system, we give the priority to the dialogue and not to the debate", answered us the spokesman of the Insurer. The answer of the group is thus dedicated to Pierre-Yves Maillard.

This last one refutes to have wanted to be involved in controversy. " I wanted to provoke a discussion about a problem which seems to me fundamental. The insured, to my opinion, are not "customers" as the others and cannot be thus treated as such. I do not underestimate the risk of medical overconsumption, actively encouraged by certain healthcare providers. More deeply, we do not choose to fall ill and it is against the spirit of LAMal itself to consider a patient as a bad customer."

"On the other hand we can attempt  to identify the insurants who consume too much or healthcare providers who grow to the consumption. But it is about a fight against bad practices, not about a selection of risks there. And the question remains opened to know if health insurers are the best health actors to lead this fight."

Pierre-Yves Maillard was not the only one to react to the comments of Pierre-Marcel Revaz. A reader in her sixties worried about the same passage. She asserts that her demand of membership to Groupe Mutuel did not receive answer during three months. Even there, the health insurer refuses to enter the debate: It respects the law but cannot exclude administrative false notes.

To make the difference between of such false notes, even excesses of zeal on behalf of brokers and deliberated policies is not easy. "When my services receive a complaint, they contact the concerned insurance. This last one assures that it is about a punctual problem and assumes that it is going to do what is necessary ", comments Pierre-Yves Maillard.

The possibility of drawing the attention of the Federal Office of  Health Service ( OFSP ) remains opened. This last one is loaded with the surveillance of health insurers. The member of the Council of State moreover sent to this office a copy of his letter to Pierre-Marcel Revaz. But the OFSP collides with the same practical problems involving punctual denunciations. And the Federal Office can better act, as it did recently by a warning, with regards to discriminations ensuing from the conception of insurers Internet sites.