Extension of the waiting period and reduction in remuneration in the public sector, reduction in the compensation ceiling and “public order waiting day” in the private sector… In the midst of the debate on the Social Security financing bill, proposals and amendments aimed at making savings to fill the gaping public deficit are multiplying. In the sights of certain ministers and parliamentarians: the surge in sick leave expenses. Since 2015, excluding the Covid period, they have increased by 52%. In 2024, they are expected to exceed 17 billion euros, compared to 10.4 billion less than ten years ago.
The first explanation is simply demographic: the active population is aging, since we are working later and later, with successive pension reforms. There is then a price factor: the minimum wage, indexed to inflation, has been revalued several times in recent years and salaries have partly followed the increase in the cost of living. These two elements account for approximately 58% of the increase observed since 2015. The rest – 42% – is due to multifactorial causes that Health Insurance is currently struggling to fully discern: the relationship to employment, the increase occupational illnesses, deterioration of working conditions… But also abuse and fraud. To sustain our health system, it is on these last two levers that the government can act in the short and medium term.
Crack down without stigmatizing
It’s about not hanging around. The Social Security deficit is expected to swell to more than 11 billion euros this year, compared to 8.8 billion in 2023. And as the French population continues to age – in 2040, 1 in 3 inhabitants will be over 60 years, compared to 1 in 4 currently – health spending will continue to grow inexorably. The challenge today is to crack down, without stigmatizing workers, businesses or doctors.
A balancing act. At the beginning of September, the National Health Insurance Fund (Cnam) announced that it would contact 7,000 general practitioners prescribing more work stoppages than the average, provoking an outcry from the MG France union . However, we will have to involve all the players, at the risk of offending some of them. In 2023, Cnam was able to recover 200 million euros thanks to its actions. Still too little to make a difference.