The Directorate of Research, Studies, Evaluation and Statistics (DREES) published at the end of 2024, as it does each year, very interesting data on the life expectancy of the French, as well as on their hope of life without incapacity. The news is generally good! Life expectancy at the birth of women is 85.7 years and that of men reached 80 years old, a level above 2019. The effect of the covid pandemic is thus erased. In fifteen years, women have won 1.4 years of life expectancy at birth and men, 2.4 years old. Better still, life expectancy without incapacity at 65, that is to say without health problems limiting daily activities, is today 12 years for women and 10.5 years for men be A gain of almost 2 years in 15 years!
At 65, life expectancy without strong incapacity is also growing: 18.5 years for women and 15.8 years for men. Overall, the latter progresses faster than life expectancy. Note that, at birth, life expectancy without incapacity has decreased by 3 months for women (64.2 years) but increased by 8 months for men (63.8 years). These data place France among the best classified within the European Union, notably after the Scandinavian countries.
How to interpret this data? The progression of life expectancy without incapacity after 65 suggests a decline in the age of appearance of chronic diseases linked to aging (degenerative neurosensory diseases, cardiovascular diseases, cancers) as well as better care of pathologies in particular acute. In the first case, we can take into account an increase in the application of drug and non -drug prevention measures (physical exercise, better nutrition, reduction in the use of alcohol and tobacco); In the second, an effect of progress in medicine.
Can we fully satisfy these results? Certainly not, if we consider the persistence of important social inequalities in life expectancy (up to 8 years apart between the French most disadvantaged and the wealthiest) and the inequality of access to care linked to the profile to distribute the supply of care in the territory. By default, this inequality indicates that one should be able, by correcting it, lead to better results, similar to those obtained in Scandinavia.
Useful expenses, but to control
In addition, the increase in life expectancy mechanically leads to an increase in the number of people with chronic diseases related to aging. This contributes, with the evolution of medical innovation prices, to the increase in health spending: 325 billion euros in 2023 in France, or 11, 8 % of GDP, regularly growing for years. It is comforting to observe that these expenses correlate with an increase in health indicators, but the question arises of financing these expenses which we know that they will grow.
There are certainly margins of progression: we can see that prevention expenditure represents only 7.5 billion, or 2.3 % of the total health expenses. It is surely possible to do better, and this in many directions. It is admitted that a significant proportion of prescriptions is not justified as many exams and treatments. Just prescription incentive measures had to be reinforced. Furthermore, how can we not be surprised by the duplication of management fees linked to duplicates between health insurance and complementary health? Could we not think about the implementation of a unique system, likely to save several billion euros?
Finally, within health expenses the share linked to the purchase of drugs continues to increase (at least 33 billion), due to the cost of innovative drugs. We would like to see a better price regulation, ideally on a European Union level as was the cases for the purchase of covid vaccines. Our health is expensive, it will undoubtedly cost even more tomorrow, but DREES statistics are the resulting hope that these expenses are useful – provided they improve its efficiency.
Alain Fischer is professor emeritus at the Collège de France and co -founder of the Institute of Genetic Diseases
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