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The origins of health insurance


You all know Health Insurance, Social Security, Mutuals ... What you may not know is that the idea of ​​creating these structures dates back to about 200 years ago. Indeed, a precursor, a philanthropist by the name of Piarron de Chamousset established a project and plan for the Association House in 1754 for care accessible to all! The ancestor of "our maid Health Insurance » !

Piarron de Chamousset the philanthropist

The eldest of his family, Piarron was born in 1717. Magistrate at the Chambre des Comptes, once his business for the day had been settled, he became interested in medical disciplines, in existing remedies and devoted the rest of his time to the various ways of treating art of healing. Soon his house resembles a hospital where he receives a hundred patients a day, sometimes two hundred, who find at home all the help they could have had in a wealthy hospital. He gives remedies and sometimes performs surgery, with a skillful and dexterous hand.

He then thought of a system based on the principle of a low contribution allowing everyone to have access to healthcare.

The first health insurance plan of 1754: the basics

In 1754, he decided to publish a "Plan of a House of Association in which, by means of a very modest sum, each associate will ensure in the state of illness all kinds of help that one can. to desire ". This fifteen-page booklet responds to three basic principles, including according to him: the expense on the part of the sick, the intelligence of those who treat the patients, the zeal of those who care for them. He finds that even the rich cannot always access the last two principles ... not all doctors are zealous!

Chamousset thinks especially of the large number of people, not rich enough or not always having the time to procure sufficient aid, "those who perish victims of their condition, such as artisans, merchants, men who live from their daily life. job ".

Of course, the establishment should also accommodate the rich, the treatment of the disease having to be the same for the rich and the less well-off, and the expenditure of the associates proportional according to their wealth "that decency does not prevent anyone from profiting. of the system ".

This House of Association would be shared in places for contagious diseases and for pregnancies. In the event of an incurable disease, the associate would be returned any funds donated. The partner will come out of the house completely cured, but if he relapses, he may return immediately. In the event of an epidemic or if the house is completely full, the partner would be entitled to his home, to the same care with doctors, drugs, broths, food.

The buildings of the Association House

Its building would be spacious, divided into lodgings assigned to people according to their condition: one building for men, one for women, the service staff being of the same sex as the patients installed. A pharmacy would be available as well as doctors and surgeons attracted by the honor of fulfilling their task and by the salaries received. They would be assisted by nurses for the care to be given. Young doctors would supplement the staff, accommodated and fed for a modest pension, these representing a useful aid to the surgeons in order to report on the progress of the cure. Ordinances would be written and placed next to the sickbed. De Chamousset provided for the daily presence of two renowned surgeons from Paris to exchange ideas on symptoms and diseases; a report on the treatment and remedies that have worked well for common illnesses would be published monthly.

His plan included a contribution table based on the partner's age and room type for long-term care. The amounts would be small, so the public approved without discussion, but there were still questions about the scope of care in return for a small fee! Chamousset had made statistics: out of a hundred people, there are no more than twelve patients in a year; illnesses never lasted more than a month.

He gave it a try and opened a house near the Barrière de Sèvres, offering two apartments, four single bedrooms, four twin bedrooms and a six-bed room, the rest of the house being reserved for staff. According to his calculations, he could accommodate 2,000 associates, but would only accept 1,200. He offered to send a coach at his own expense to look for the patient, but he had to face several obstacles: once the field was unsuitable for such a destination; another time a Great "stood in the way"; in vain… the first stone was not laid!

The second draft of 1770

In 1770, De Chamousset wrote a “memoir on health insurance companies” in which he asked the king to be able to set up a company “because it is the wisdom of governments to authorize any company that has a useful purpose and to appoint commissioners to ensure that the promises made to the public by these companies are fulfilled ”. It is based on the existence of insurance against shipwrecks and fires, so why not insurance against illnesses even if the risk is more frequent; and "the more the companies heal the sick, and the faster they heal, the more associates will come to register and contribute."

In this new brief, he also wants to expand his establishment to increase to 30,000 insured, with three hundred beds divided into four different classes: 16,800 associates installed in rooms with twenty-four beds, beds separated by partitions, the front closed. by a curtain, the contribution would be twelve pounds per year per bed; 9,600 associates distributed in forty eight rooms with two beds, bed covers and painted curtains, a particular fire and a guard, a contribution of twenty four pounds per year per bed; 3,000 associates for thirty one-bed rooms, furnished room, service provided as a rich man can be at home, if he wishes by his servant who would be fed by the establishment, a contribution of thirty pounds per year ; 600 associates in six three-room apartments, an antechamber with a private drink, care provided by the establishment, the membership fee would be sixty pounds annually.

The minimum age would be ten, and a maximum of fifty, with an additional clause: entered into the association without having left it, one could not be excluded from it whatever age one arrives; relief and care would be identical in all classes "same surgeons, same doctors, same broth and same drugs".

For him, it was a viable project: with his calculations, he would get revenue of 576,000 pounds for expenditure of 288,000 pounds. He would share an amount of 240,000 pounds from the balance to expand the premises, and a "distribution among the 3,000 shareholders who would subscribe at the rate of 200 pounds per share, each giving 80 pounds of annuity." These actions would give an immediate contribution of 600,000 pounds to rebuild a house with three hundred additional beds….

However, Medicare did not see the light of day ... before 1945

To arrive at the construction of his House, De Chamousset proposed a lottery "the tickets, numbering 30,000, at the rate of one ticket for each place of partner, would give 900 lots, of which the highest of 600 pounds and the lesser of 10 pounds, would be taken out of the profits up to 27,630 pounds ”, thus he would recover potential customers!

Everyone approved of his plan, it was "sweet to think that you could see the disturbance of his health, by the certainty of seeing at the same time all the means dependent on humanity coming together to restore it". He even proposed to exclude himself from the shareholders, to reform the project according to new ideas ... nothing helped! Few people wanted to untie their purse strings ... and really, a similar system did not come into being until 1945 ... about 200 years later!

Source: Picturesque France reviewed for the 3rd quarter of 2011: extracts from "Complete works of M. de Chamousset" published in 1783 - "Journal des savants" published in 1770 - "Views of a citizen" published in 1757


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