How to make savings in the “social security” budget? Michel Barnier has until now remained quite vague on this subject. Of the 40 billion savings envisaged in the budget, a significant part must come from social security, in addition to the efforts required of the State and local authorities.
But one of the avenues mentioned by the Prime Minister – namely making retirees contribute more by only increasing their pensions on July 1, 2025 and not on January 1 – already seems to be in decline following political differences on the subject. However, this effort would bring in 4 billion euros to the State.
If the “retirement” branch is not used, it will therefore be necessary to find more sources of savings in the “illness” branch of social security. The decisions will be made this Thursday, October 10 during the presentation by the government of its Social Security Financing Bill (PLFSS), the overall envelope of which was 640 billion euros in 2024, including 250 billion for “disease” branch. Already, some of the measures envisaged show that health spending will be heavily impacted.
Hospitals and clinics urged to be frugal
Hospital budgets – public and private – are set by the level of the National Health Insurance Expenditure Objective (Ondam). The most important decision of this PLFSS is that the Ondam will “only” increase by 2.8% in 2025, barely more than inflation, while it had increased by 3.2% in 2024, according to data provided by the executive to different health federations.
This therefore means that the budgets of public and private hospitals, which were 105 billion euros in 2024, will be constrained. It is not the dry regime either, but the end of the years of growth in post-Covid budgets, which made it possible to once again attract caregivers to the hospital, thanks to salary increases.
ALSO READ Health: the hot issues awaiting the new ministerTuesday October 8, the president of the Federation of Hospitals of France Arnaud Robinet declared that “this level of Ondam will prevent hospitals from making investments, and penalize their recruitment. The current budgetary context requires a spirit of responsibility. But health cannot be sacrificed on the altar of pension fund deficits.”
Lamine Gharbi, president of the Federation of Private Hospitals (FHP), also does not hide his anger: “We will no longer be able to treat people, and we will no longer be able to invest. Many clinics are facing bankruptcy with these restrictions. We are penalized more than the public, while we work more in the private sector, this is not normal. » Autumn could therefore be hectic at the hospital. Several associations and large federations, particularly in the medico-social and private non-profit sector, believe that health is “sacrificed” with this diet.
Medical consultations less well reimbursed?
How can we find money, then, to also finance community care? The budget devoted to community medicine should hardly exceed 108 billion euros. However, we must finance the increase in the basic consultation, which will increase from 26.50 euros to 30 euros on December 1st.
In this inflationary context, how can we save money on “social security”? The government is working on the idea of lowering the amount of social security reimbursements for medical consultations from 70% to 60%, according to The Echoes. The share of complementary funds would increase from 30% to 40%. The “social security” part was until now 21 euros and the mutual part 9 euros, on a consultation with the general practitioner at 30 euros. If the new system was adopted, this would increase the “social security” part to 18 euros, and the mutual part to 12 euros.
“Twelve euros is a lot to pay for people who don’t have mutual insurance. And this will inevitably cause an increase in the price of mutual insurance contributions,” predicts Gérard Raymond, president of France Assos Santé. Contacted, the office of Laurent Saint-Martin, Minister of Budget and Public Accounts, did not comment, and referred “to the presentation of the PLFSS on Thursday”.
ALSO READ Hospital: why there is a shortage of a thousand interns this yearFor his part, one of the directors of a large mutual gives credence to this approach, because he specifies that his services have “estimated the savings that this would make to Health Insurance at 1.2 billion euros, during an exchange with the Social Security Directorate. But officially, it is not confirmed. For the record, this coverage at only 60% has already been the standard in dental care since the summer of 2023.
Another possible avenue is to make all or part of the 12 million patients with long-term illnesses (ALD) – treated for cancer, diabetes, cardiovascular diseases, etc. – contribute more. –, whose care is 100% covered. “But politically, making patients with serious pathologies contribute more is not easy to get across in public opinion. Even if the reality of the figures shows that it is ALD patients who weigh the most in health accounts,” adds a doctor.
Work stoppages and patient transport in the crosshairs
Expenditures devoted by health insurance to “daily allowances” are in the crosshairs. Michel Barnier declared – after others – that “we must limit the cost of work stoppages” in an interview with La Tribune Sunday. Despite numerous communication campaigns on this subject, their amount increased by 8.5% in 2024, to stand at 16 billion euros.
Health Insurance wants to offer an “SOS IJ” service, allowing doctors to contact it “in complex work stoppage situations”. A list of doctors supposed to be too lax is being drawn up… which irritates a large part of the profession who does not want to be “stalked”.
Another avenue for savings concerns the transport of patients, the expense of which increased by 9% in 2023, to reach the enormous figure of 6.4 billion euros. Health Insurance proposes, as part of this PLFSS, “an action plan to verify the relevance of transport”. This is especially the case with taxi expenses. The fight against “social fraud” in this sector is declared a priority. Furthermore, the conditions of access to state medical aid could be tightened.
