This is one of the keystones of his plan to “debt France”. During the Assises des finances publics, Bruno Le Maire announced that he wanted to put an end to “absenteeism”, a disease which, according to him, is spreading at full speed in our country, in particular since the Covid-19. Words that he knows are controversial, in the same vein as his recent charge against “social fraud” a month ago. In fact, the number of work stoppages has increased by 30% since 2012, which represents “a strong dynamism”, according to Health Insurance. The number two of the government therefore hopes to glean “several hundred million euros” from the expenditure of daily allowances, with an emphasis on the “drifts” of the system and the imaginary patients. However, it is not certain that these savings are easy to mobilize.
Excluding Covid, the budget devoted to work stoppages reached 14 billion euros in 2022, up 7.4% compared to the previous year. But part of this increase turns out to be linked to incompressible factors. Wage inflation, “the employment rate […] and the aging of the active population”, weigh heavily in the balance, recalled the Court of Audit in a report published in May. “Exogenous” causes which are often not taken into account in the objectives “driven by the public authorities”, according to the institution.
The government has also generated some of the new spending that worries it today. Thus, more and more young dads are taking their paternity leave since Emmanuel Macron decided in 2021 to double the number of days compensated for this. For that year alone, the parenting stops cost 3.3 billion eurosi.e. one-fifth of total expenditure on daily allowances and 9% more than in 2014, while at the same time the birth rate fell by 10%.
The backlash of government measures
Added to this is the pension reform, which will very quickly complicate the equation. Several hundred thousand seniors will remain in employment in the years to come. However, in this age group, work stoppages are more frequent than in the rest of the population. “The government should have anticipated these many elements, but it preferred to make health a scapegoat,” says Agnès Giannotti, president of MG France, the country’s leading GP union.
This greatly limits potential savings. To achieve its objectives, the executive intends to first tackle fraud on sick leave: 30 million euros in expenditure would be directly attributable to them. The Minister of Public Accounts, Gabriel Attal, announced a few weeks ago the training of 450 cyberinvestigators within Health Insurance. They will have to fight against the sellers of false work stoppages, which have swarmed on social networks in recent weeks.
And for the rest ? Where to find something to improve public finances? Bruno Le Maire does not specify. “There are no ready-made solutions. Nothing has been decided,” Bercy cautiously concedes to L’Express. The minister leaves until the fall to identify the “most effective instruments” against abuses. Time to discuss with employers’ organizations, the National Health Insurance Fund and doctors. But even before the meetings have taken place, everyone is already passing the buck.
On the seventh floor of Bercy, where the Assizes of Public Finances were held, Bruno Le Maire had notably hinted that daily allowances could be borne more by companies. No question, immediately retorted Geoffroy Roux de Bézieux, the president of Medef, in concert with the Confederation of small and medium-sized enterprises. The boss of bosses proposes that a day of waiting called “public order” remains the sole responsibility of employees, and could no longer be compensated by companies.
One more day off?
“That would not solve the problem, because the tool is already not very dissuasive”, estimates Anne-Sophie Godon-Rensonnet, director of services at Malakoff Humanis, one of the main social protection groups in the country, which carries out numerous studies on the work stoppages. According to its latest barometer, published in June and conducted on 2,000 people by Ifop, only half of private sector employees see their salary maintained during the three days of waiting already in force. In other words, many are already financing their short absences themselves.
And if the stoppages increase, “paradoxically, more and more workers do not dare to take them”, recalls Anne-Sophie Godon-Rensonnet. A quarter of the employees surveyed said they did not perform all of the stops prescribed for them. Nearly 70% of private sector employees would work while suffering, an increase of 9% compared to last year. Patients who stop are increasingly controlled by companies and health insurance, according to insurance studies. This did not prevent the counters from exploding.
Should we then target doctors, who could sometimes prescribe too much, badly, or out of “complacency”, according to the formula of Geoffroy Roux de Bézieux? Considering in the first place that teleconsultation could encourage such abuses, the executive had tried to have the judgments issued remotely reimbursed. But the measure was rejected by the Constitutional Council at the end of 2022. Asking doctors to have the prescription less easy would also risk reinforcing the distrust and anger of the profession.
After the efforts made by the medical profession during Covid-19, the timing is particularly bad. Since 2014, Health Insurance has been sending letters on a regular basis to the thousand most prescribing GPs (2% of the total), in an attempt to convince them to do less. If the operation is common, the last edition was perceived as a “pressure blow” by the unions, because of the news.
A blind fight
For its part, the government is advancing blindly: the available statistics are not fine enough to determine precisely why such and such a practitioner gives more or fewer stops. In its latest report, the Court of Auditors thus recommended to “enrich the medical and life data of the patient […] in order to improve the actions of medicalized control and their evaluation”. The arrival of electronic prescriptions was supposed to partly solve the problem, by facilitating real-time monitoring, but few doctors got into it.
Business leaders and doctors agree on at least one point. Quiet quitting, depression of executives… a form of malaise is spreading, and weighs in the balance. Long arrests for psychological disorder have doubled in the space of three years, according to the Malakoff barometer. Among the main reasons, respondents cite inappropriate tasks or objectives, and harmful managerial practices. “It would be a shame to reduce the subject to control and the waiting day. We must engage in substantive reflection on the origin of this discomfort”, pleads Anne-Sophie Godon-Rensonnet. Right to disconnect, training in first aid in mental health… What to answer to those who do not pretend, who can no longer do it? Another impossible project in perspective.