The Social Security deficit will be greater than expected in 2023 and 2024, then will widen and double by 2027, according to the draft Social Security financing law, consulted Tuesday by AFP. The deficit this year is now estimated at 8.8 billion euros (compared to 8.2 billion planned in the last financing law in April), then at 11.2 billion in 2024 (compared to 9.6 planned in April). The “hole” should then reach 15.8 billion euros in 2025 (compared to 13 mentioned so far), then 17.5 billion in 2026 and 17.9 billion in 2027.
The expected deficit thus rebounds stronger than expected and qualifies the executive’s promises of recovery of public finances. Bercy is, in fact, calling for a rigorous cure, particularly in health where spending has slipped by several billion euros in 2023. The national health insurance spending objective (Ondam) is now projected at 247.6 billion euros, compared to 244.8 initially forecast in April.
The gap is explained by salary increases at the hospital to stem the flight of its staff (salary measures, better remuneration for night and weekend guards), and by a greater than expected increase in community care , “in a context of high inflation pushing up certain expenses”, such as compensation for sick leave, details the text. For 2024, the government plans 254.9 billion in spending for Ondam.
In recent months, Health Insurance has negotiated price increases with several categories of caregivers, in exchange for compensation to combat medical deserts. It should also quickly resume negotiations with private doctors this fall: the Minister of Health, Aurélien Rousseau, has promised that the 1.5 euro increase in consultations (26.50 euros for general practitioners, 31.50 euros for the specialist) in force on November 1 was only a “step”.
In its preliminary bill, the government also puts forward “measures for medical control and the fight against fraud”. In an amendment to the public finance programming bill, currently being examined in the National Assembly, the government had already indicated that the national health insurance spending objective would increase by 4.8% (excluding Covid) in 2023 – compared to 3.8% initially planned – then 3.2% in 2024. “Over a multi-year period, the rate of progression of Ondam would be reduced to 3.0% in 2025, then to 2.9% in 2026 and 2027,” says the government’s draft bill.
The government also anticipates that the deficit in the old-age sector will continue to widen as expected, but less quickly than expected in the wake of the pension reform, with no explanation at this stage. It is expected to go from -1.9 billion in 2023 to -13.6 billion in 2027.
Also included in the draft bill are measures relating to medicines, in particular to combat shortages. In the event of supply disruptions, the Minister of Health may make the delivery of drugs to the unit and the carrying out of rapid diagnostic tests (Trod) compulsory. A “conditional prescription” system thus allows the doctor to prescribe an antibiotic subject to the positive result of the Trod carried out in the pharmacy.
The Minister may also limit or prohibit the prescription carried out by an act of teleconsultation of certain medicines affected by shortages. The option recommended by patient associations, which consisted of extending the duration of stocks, was ruled out.