In a report published this Wednesday, May 29, the Court of Auditors sounds the alarm: the State has lost “control of social accounts”. And calls on the executive for a “redress” of social spending, which it considers “necessary”.
The magistrates identified two main explanations for this observation. The first, the deficit in the basic compulsory social security and old-age solidarity fund schemes. In 2023, this reaches 10.8 billion euros, an increase of 3.7 billion compared to the forecasts of the 2023 financing law.
The health branch, the burden of Social Security?
An aggravation, the responsibility for which would fall solely on the health branch, according to the Sages of rue Cambon who specify that “the reduction of 9.9 billion euros in its deficit compared to 2022 is entirely attributable to the almost extinction of expenses linked to the health crisis (- 11 billion)”. For the rest, “the disease branch alone bears the entire deficit, the surpluses and deficits of the other branches, which are much smaller, compensate for each other”, explains the report.
Public hospitals and nursing homes also appear to be the worst sufferers of social spending “with increasingly high deficits and significant disparities between establishments depending on the way in which they manage to reconcile the evolution of their activity and the growth of their costs “.
Expenses still too high
The second then, the exponential increase in health insurance spending over the last five years: plus 5.4% per year between 2019 and 2023. For comparison, the annual increase over the period 2015-2019 did not exceed 2, 4%. From around 200.4 billion in 2019, social spending reached 246.8 billion euros in 2023. It is therefore clear that the savings planned in the initial financing law did not produce the expected effects.
The Court of Auditors is particularly concerned about the trajectory taken by the government “which does not ensure the return to balance in health insurance”. And for good reason, the Social Security financing law (LFSS) for 2024 set the national health insurance expenditure objective (Ondam) at 254.7 billion, or 3.2% more than in 2023. Translation of a “relaxation of financial constraints”, say the wise people.
Some ideas for cleaning up Social Security accounts
According to forecasts from the Rue Cambon institution, expenditure will continue to increase by 3% per year until approaching 280 billion euros in 2027. An “unsustainable” situation, the Court says. This is why the report encourages the executive to explore different avenues which will “ensure a lasting recovery of social accounts”.
The approximation to common law of salary supplements. These “social niches”, divided into five categories, have the particularity of being exempt from social contributions. Result: “The revenue losses induced for Social Security between 2018 and 2022 reached 8.1 billion euros, an amount greater than the deterioration of social deficits excluding Covid (6.6 billion)”, warns the Court of Auditors.
Sick leave, a constantly increasing burden
The report also recommends an overhaul of the operation of compensation for sick leave, which is based on “old and complex rules”. Currently shared equally between Social Security and businesses, the cost of sick leave increased by 4.3 billion between 2017 and 2022, an increase of 56%.
According to the Sages, progress could be curbed by a simplification of regulations “that have become too complex”, with the diversification of situations, particularly for the calculation of compensation due to intermittent workers, “who combine several activities or are unemployed”.
“If progress is made in IT, the conditions for granting rights and the methods for calculating the reference income could be simplified,” argued the Court, which estimated the management costs at some 400 million euros per year.
Among other “possible measures”, the Wise Men cite the non-compensation by Health Insurance for sick leave of less than 8 days (470 million euros less expenditure), the increase to 7 days of the waiting period (950 million euros less expenses), the reduction to two years (compared to three today) of the maximum duration of compensation (750 million euros less expenses)…