2024-10-22 18:53:00
On October 10, on the occasion of the announcement of the PLFSS for 2025 and an Ondam of 2.8%, while the needs are significant, Les Counterpoints de la Santé, of which we are partners, have received Thomas FatômeDirector General of theHealth Insurance. In fact, the chronic deficit of Health Insurance risks calling into question its sustainability or at the very least, its missions. What future for the woman who, next year, will celebrate her 80th birthday? What actions should you take? Philippe Leduc, Pascal Maurel and our director, Renaud Degastook stock with their guest.
“The financial situation of Health Insurance is difficult, recognized Thomas Fatôme in the preamble. It’s a reality. » After “Covid-19” et “the inflation shock which had a huge impact on the city and the hospital”, ” We let’s come out of all this with a deficit of 13-14 billion euros. This is obviously a structuring element for us, Health Insurance, as an institution,” a “invitation, an incentive, an absolute necessity to further strengthen our actions”he mentioned. And to add: “I believe that we need to be aware of the fact that we will have to collectively find ways and means to restore the sustainability of Health Insurance”.
And this, especially since for 2025, the Government’s projections in the PLFSS anticipate an overall deficit of 18 billion euros in 2024 and 15.7 billion euros in 2025 for Social Security, despite efforts to save money.
Which raises questions about the growing challenges linked to controlling health spending and financing the system. Should revenues be increased? “This will be discussed in Parliament” ; this being said, “we are in a country which has a high level of compulsory levy”THE “room for maneuver is limited, we know that”replied the CEO of Cnam. Brief, “my mission is clear: it is to work on expenses and that is what we are trying to do”.
Control of expenses, fight against fraud
The debate was thus an opportunity to talk about savings, transfers from AMO to AMCs, strengthening of preventionimprovement of the relevance of care and prescriptions… but also fight against social fraud.
Fraud is, to date, estimated at approximately 13 billion eurosaccording to the High Council for the Financing of Social Protection. Mr. Fatôme specified that it concerns different sectors: 56% of companies, 34% of policyholders and 10% of health professionals. Cnam thus intends to recover around 500 million euros in 2024 (compared to 290 million euros historically), by gradually increasing its efforts to better identify and sanction this fraud. And this, by treating each type of fraud specifically, depending on the sectors concerned. The planned measures include improving controls on medical ratings, checking abusive practices and better organization of control teams.
Thomas Fatôme also insisted on the importance of strengthening links between different health professionals to improve the efficiency of the system. In his eyes, the CPTS play a key role in the coordination of care at territorial level. He also recognized that the territorial network is progressing wellwith approximately 85% of the national territory covered. But he recalled the need to demonstrate their effectiveness by producing concrete results, particularly in terms of pathways and access to care, to monitor actions and to ensure proper use of allocated funding.
My health space and the battle of usage
During the debate, Thomas Fatôme also addressed the question ofsupervision of teleconsultationsindicating that progress had been made with the establishment of specifications for the platforms, voted in the PLFSS of the previous year. The objective is to regulate this practice while ensuring its complementarity with the existing care offer, particularly in medical deserts, he pointed out. He also mentioned the need to launch teleconsultation foundations to better define its framework and its role in the health system.
On the aspect of digital health, the initiative “ My Health Space » was also highlighted. In fact, 15 million policyholders have already activated their digital health record and nearly 500,000 connect to it every week. “It’s a great dynamic, now we have to remain modest,” put the Director General of Health Insurance into perspective.
There is “a lot of work” pour “win the battle of uses” and ensure, with software publishers and all stakeholders, that access to My health space “be fluid, simple, ergonomic”. And, of course, that the tool is “completely integrated into daily practice” health professionals as in the minds of the French.
For now, “35% of French people use it regularly and 41% see what it is but use it much more occasionally”, according to an exclusive Viavoice survey revealed during Contrepoints de la santé. On the other hand, “22% of French people” do not know of the existence of My health space.
The feeling of a drop in reimbursements
Presented by Adrien Brocheresponsible for political studies published at Viavoice, the survey also revealed that 72% of French people judge the complementarity between health insurance and complementary health insurance “satisfactory”. 62% nevertheless have the feeling that, in recent years, healthcare reimbursement by Health Insurance has been less and less effective.
“And yet, what we see at the macro level is rather an increase in the level of coverage, overall, of Health Insurance because it carries the heavy risk”estimated the DG of Health Insurance. And if the Government or Parliament “confirms certain choices”for example the increase in the co-payment (from 30 to 40%, as is currently envisaged), “this also means that they confirm that the 100% system” support for people in ALD “is completely preserved”he concluded.
View the full results here or on the Viavoice website.
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Interview with Thomas Fatôme, Director General of Health Insurance
Interviewer: Thank you for joining us today, Mr. Fatôme. You recently stated that the financial situation of Health Insurance is quite challenging. Can you elaborate on the causes of this deficit?
Thomas Fatôme: Certainly. The primary factors contributing to our current deficit of approximately 13-14 billion euros stem from the aftereffects of COVID-19 and the inflationary pressures that have hit both city and hospital services hard. This has compelled us to rethink our strategies to ensure the long-term sustainability of health care in France.
Interviewer: The recent PLFSS for 2025 projects an even greater deficit of 18 billion euros for 2024. What measures are being considered to address this growing gap?
Thomas Fatôme: We have to focus on controlling health expenses. While there is ongoing discussion in Parliament about potentially increasing revenues, the reality is that our country already has a high level of compulsory levies. Our room for maneuver is limited. Thus, my primary mission is to work on reducing expenses and managing funds more effectively.
Interviewer: You’ve mentioned the need to combat fraud within the system, which is estimated at around 13 billion euros. What specific actions are being planned?
Thomas Fatôme: Our goal is to recover approximately 500 million euros in 2024 by enhancing our fraud detection and sanction mechanisms. This will involve more stringent controls across different sectors, particularly focusing on companies, policyholders, and health professionals. We’ll be improving our processes for identifying and addressing various types of fraud.
Interviewer: Shifting gears to the digital aspect of health services: how has the initiative “My Health Space” been received, and how do you plan to enhance its usage among the French population?
Thomas Fatôme: “My Health Space” has gained momentum, with 15 million policyholders activating their digital health records. However, we are aware that only about 35% of the population uses it regularly. Our focus will be on improving the user experience to encourage more frequent use and awareness, ensuring that it integrates seamlessly into the daily practices of both health professionals and patients.
Interviewer: Lastly, as we look forward, how can Health Insurance maintain its critical missions if the situation does not improve?
Thomas Fatôme: It’s crucial for all stakeholders to commit to finding solutions together. We need an efficient, coordinated health system that emphasizes prevention, care relevance, and better resource management. The health of our patients depends on how effectively we can navigate these challenges, and I believe that with our collective efforts, we can restore the system’s sustainability.
Interviewer: Thank you, Mr. Fatôme, for sharing these insights with us today.
Thomas Fatôme: Thank you for having me. It’s vital to keep this conversation going as we work towards a healthier future for everyone.
Interview with Thomas Fatôme, Director General of Health Insurance
Interviewer: Thank you for joining us today, Mr. Fatôme. You recently highlighted the serious financial challenges facing Health Insurance in France. Can you elaborate on the primary causes of this deficit?
Thomas Fatôme: Absolutely. The current deficit of approximately 13-14 billion euros is largely attributed to the lasting effects of the COVID-19 pandemic and the significant inflationary pressures that have affected both urban and hospital health services. These challenges have forced us to reassess our strategies to ensure the sustainability of our healthcare system moving forward.
Interviewer: The recent PLFSS for 2025 projects an even larger deficit of 18 billion euros for 2024. What measures are being discussed to tackle this increasing gap?
Thomas Fatôme: Our primary focus must be on controlling health expenditures. While there is an ongoing discussion in Parliament regarding potential revenue increases, we must face the reality that our country already has a high level of compulsory levies, which limits our options. Consequently, my main mission is to reduce expenses and manage our resources more efficiently.
Interviewer: You mentioned combating fraud within the Health Insurance system, which is estimated at around 13 billion euros. What specific actions are in the works to address this issue?
Thomas Fatôme: We aim to recover approximately 500 million euros in 2024 by enhancing our fraud detection and enforcement mechanisms. This will involve tightening our controls across various sectors, particularly targeting companies, policyholders, and health professionals. By improving our processes for identifying and addressing different types of fraud, we can make significant strides in rehabilitating our financial situation.
Interviewer: Turning now to digital healthcare innovations, how has the initiative “My Health Space” progressed, and what impact is it having on patient care?
Thomas Fatôme: “My Health Space” is gaining traction, with 15 million policyholders having activated their digital health records. Nearly 500,000 users connect to the platform each week. However, there’s still a considerable amount of work to be done to ensure that its usage is widespread and intuitive. We need to promote its accessibility and integration into the daily practice of health professionals to truly optimize its potential within our health system.
Interviewer: Thank you for those insights, Mr. Fatôme. It seems there’s a lot to navigate in the coming years to ensure the sustainability of Health Insurance in France, and your leadership will be key to addressing these challenges.
Thomas Fatôme: Thank you for having me. It’s essential that we work collaboratively to navigate these complex issues and secure a healthier future for all citizens.
