Last June, the Social Security Accounts Commission predicted a deficit in its health insurance branch of 11.4 billion euros. During a press briefing on Monday, September 10, the director of the National Health Insurance Fund, Thomas Fatôme, announced that the bill was likely to be even higher.
The cause: several demographic factors such as the evolution of the working population, the aging of the population. But also economic factors such as the increase in the average salary or the minimum wage, for example. Between 2019 and 2023, annual expenditure related to daily allowances (excluding Covid) increased from 12.4 to 15.8 billion euros (an increase of 27%). According to Health Insurance, around 40% of this increase is attributable to a “price effect”. It was almost half as much between 2010 and 2019.
Thus, in 2022 and 2023, the number of daily allowances increased less quickly than in previous years. On the other hand, the amount of expenditure continued to increase at a sustained rate, in particular because of the increase in salaries which increases the price of the allowances paid.
According to Health Insurance calculations, however, a large part of the recent increase cannot be explained by these criteria alone. Other factors, to be determined, clearly come into play, as Thomas Fatôme explains. 42% of this increase is linked to the increase in sick leave and its lengthening. “It is an important, difficult, complicated debate”, which will undoubtedly affect “the state of health of a part of the population, living conditions at work” or a “different relationship to work”, he said. In a year where expenditure increases by a billion euros, as in 2024, “that makes 400 million euros” of additional expenditure unexplained by demographics and the economy, he indicated.
“Tracking down” fraud
Thomas Fatôme called for “bringing all stakeholders around the table” (government, Parliament, social partners, etc.) to conduct “a more general reflection” on the system and “make it fairer, more equitable, more readable, more sustainable”. While waiting for in-depth discussions, Health Insurance will “relaunch” and “expand” the “range of actions towards policyholders, businesses and prescribers” which, in 2023, had allowed it to cut 200 million euros from the increase in expenditure, he explained.
This involves both “tracking down” fraud and “supporting” patients and prescribers to improve practices, he added. The Cnam will therefore massively address social security beneficiaries: it will contact “all insured persons on sick leave for more than 18 months”, i.e. 30,000 to 40,000 people, to “check whether the sick leave is still justified” or whether it is possible to adapt it with, for example, “therapeutic part-time work”, or “an organized return to work”, explained Thomas Fatôme.
Some policyholders will be reminded of the rules by mail, such as the obligation to stay at home during working hours, and the Cnam will contact “7,000 general practitioners who have fairly high prescription levels” for a “fraternal exchange” with a medical advisor in order to “understand” and “see if they can contribute to better control of expenses”, indicated Thomas Fatôme.
“Sick” work
On the other hand, Health Insurance is not renewing for the time being the controls and constraints (setting targets, prior agreement) that so exasperated doctors last year. The Cnam will finally organize visits to a thousand companies with high absenteeism to check whether they are not creating “the conditions” for these work stoppages or accidents. Health Insurance is starting to deploy unfalsifiable work stoppage prescription forms, which will become mandatory from June 2025.
Faced with the position taken by the Health Insurance, the Unsa union stressed that it was necessary to “stop stigmatizing the sick”. “It is illusory to think that substantial savings will be made on sick leave without tackling the root causes: more serious and numerous illnesses, longer careers with the increase in the retirement age and constantly increasing psychosocial risks”, indicated Dominique Corona, deputy general secretary of the union. It is not the doctors who are abusing, “it is the work that is sick”, estimated for her part, Sunday on France Inter, the general secretary of the CFDT Marylise Léon.