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            <title xml:lang="fr">A quoi tient la solidarité de l’assurance maladie entre les hauts revenus et les plus modestes en France ?</title>
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                <title xml:lang="fr">A quoi tient la solidarité de l’assurance maladie entre les hauts revenus et les plus modestes en France ?</title>
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                <term xml:lang="fr">accès aux soins</term>
                <term xml:lang="fr">Assurance-maladie</term>
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              <p>This article analyses the solidarity of the French health insurance system with a new index which measures the cross-subsidies from the rich to the poor induced by health expenses and financing, using the 2012 Inès-Omar microsimulation model. The solidarity index is decomposed by financing sources (public and private insurances and out-of-pocket payments) and discussed with respect to equity principles. The solidarity is less driven by the horizontal equity in use of the system than by the vertical equity in finance insured by the progressivity of the public part of the system. The magnitude of social health inequalities explains a large part of the concentration among the poorest of public health expenses, even if the solidarity of the system is limited by barriers to access to care.</p>
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              <p>Cet article analyse la solidarité assurée par le système d’assurance maladie français grâce à un nouvel outil mesurant les transferts opérés entre classes de revenu par les consommations de soins et leur financement, appliqué au modèle de microsimulation Inès-Omar 2012. L’indice de solidarité est décomposé selon les sources de financement (assurances obligatoires et complémentaires, restes à charges) et discuté au regard de principes d’équité. La solidarité tient moins à l’équité horizontale dans la consommation de soins qu’à l’équité verticale du financement garantie par la progressivité de l’assurance obligatoire.Les inégalités sociales de santé contribuent largement à expliquer l’importance des transferts reçus de l’assurance publique par les plus modestes, même si les barrières d’accès aux soins limitent la solidarité du système.</p>
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