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Health insurance warns of the “unsustainable” growth in expenditure linked to work stoppages, and calls on politicians and social partners to address the issue (AFP/Archives/PHILIPPE HUGUEN)
As the budgetary choices for 2025 are being prepared, Health Insurance is warning of the “unsustainable” growth in expenditure linked to work stoppages, and is calling on politicians and social partners to address the issue.
According to the director of the National Health Insurance Fund, Thomas Fatôme, expenditure on compensation for people on sick leave was once again on the rise (+8%, including work accidents and occupational diseases) in the first half of 2024, and could “exceed 17 billion euros” by the end of the year.
Of course, it is normal for sick leave expenses to increase each year, due to demographic factors – changes in the working population, ageing of the population – or economic factors – increases in the average salary or the minimum wage, for example.
But according to the Health Insurance’s calculations, a large part of the recent increase cannot be explained by these criteria alone, and other factors, to be determined, clearly come into play, explains Mr. Fatôme.
“It is an important, difficult, complicated debate”, which will undoubtedly affect “the state of health of a part of the population, the living conditions at work” or a “different relationship to work”, he said.
In a year where spending increases by one billion euros, as in 2024, “that’s 400 million euros” of additional spending unexplained by demographics and the economy, he said.
– “Tracking down” fraud –
Mr. Fatôme called for “bringing all the stakeholders around the table” (government, Parliament, social partners, etc.) to conduct “a more general reflection” on the system and “make it fairer, more equitable, more readable, more sustainable.”
“Depending on the size of the companies, depending on your seniority, you are not covered in the same way” and “many insured people say that they have difficulty understanding how they are covered”, he explained, saying that he was “at the disposal” of the future government to contribute to this work.
Pending in-depth discussions, Health Insurance will “relaunch” and “expand” the “range of actions aimed at policyholders, businesses and prescribers” which, in 2023, allowed it to cut 200 million euros from the increase in expenditure, he explained.
It is a question of both “tracking down” fraud and “supporting” patients and prescribers to improve practices, he added.
The Cnam will therefore massively address social security beneficiaries: it will contact “all those insured on sick leave for more than 18 months”, i.e. 30,000 to 40,000 people, to “check whether the sick leave is still justified” or whether it is possible to adapt it with, for example, “therapeutic part-time work”, or “an organized return to work”, explained Mr. Fatôme.
Some insured persons will be reminded of the rules by mail, such as the obligation to stay at home during working hours, and the Cnam will contact “7,000 general practitioners who have fairly high prescription levels”, for a “fraternal exchange” with a medical advisor in order to “understand” and “see if they can contribute to better control of expenses”, indicated Mr. Fatôme.
– “Sick” work –
On the other hand, Health Insurance is not for the moment renewing the controls and constraints (setting objectives, prior agreement) which so exasperated doctors last year.
The Cnam will finally organize visits to a thousand companies with high absenteeism to check whether they are not creating “the conditions” for these work stoppages or accidents.
Health insurance is starting to roll out tamper-proof work stoppage prescription forms, which will become mandatory from June 2025.
Faced with the position taken by the Health Insurance, the Unsa union stressed that it was necessary to “stop stigmatizing the sick”.
“It is illusory to think that substantial savings will be made on work stoppages without tackling the root causes: more serious and more numerous illnesses, longer careers with the increase in the retirement age and constantly increasing psychosocial risks,” said Dominique Corona, deputy general secretary of the union.
It’s not the doctors who are abusing, “it’s the work that is sick”, said CFDT Secretary General Marylise Léon on France Inter on Sunday.
© 2024 AFP
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What are the key factors contributing to the unsustainable growth of expenditure linked to work stoppages in the healthcare system?
Table of Contents
The Unsustainable Growth of Expenditure Linked to Work Stoppages: A Call to Action for Politicians and Social Partners
As the world grapples with the rising costs of healthcare, a pressing issue has emerged: the unsustainable growth of expenditure linked to work stoppages. Health Insurance, a vital component of social security systems, has sounded the alarm, warning that the exponential increase in expenditure on compensation for people on sick leave is becoming unsustainable. According to the director of the National Health Insurance Fund, Thomas Fatôme, expenditure on sick leave compensation rose by 8% in the first half of 2024, with projections indicating that it could exceed 17 billion euros by the end of the year.
The Root Causes of the Problem
While demographic factors, such as an ageing population, and economic factors, like increases in average salaries and minimum wages, contribute to the rising costs of healthcare, they do not fully explain the recent surge in expenditure. Other factors, yet to be determined, are at play, and it is essential to identify and address them. The Health Insurance’s calculations reveal that an additional 400 million euros in expenditure cannot be attributed to demographic or economic factors, highlighting the complexity of the issue.
The Consequences of Inaction
If left unchecked, the unsustainable growth of expenditure linked to work stoppages will have far-reaching consequences, affecting not only the state of health of a significant portion of the population but also living conditions at work and the overall relationship between employees and their jobs. It is, therefore, imperative that politicians, social partners, and other stakeholders come together to address this pressing issue.
A Call to Action
Health Insurance’s director, Thomas Fatôme, has called for a comprehensive review of the system, urging all stakeholders to contribute to making it fairer, more equitable, and sustainable. This endeavor requires a multifaceted approach, involving the tracking down of fraud, supporting patients and prescribers to improve practices, and reassessing the current system to ensure it is accessible and understandable for all.
Targeted Measures
To tackle the issue, Health Insurance plans to relaunch and expand its range of actions aimed at policyholders, businesses, and prescribers. This includes contacting 30,000 to 40,000 individuals on sick leave for more than 18 months to assess whether their leave is still justified and exploring alternative solutions, such as therapeutic part-time work or organized returns to work. Additionally, Health Insurance will contact 7,000 general practitioners with high prescription levels to discuss ways to improve practices and reduce expenditure.
Tamper-Proof Prescription Forms
In another move to address the issue, Health Insurance is introducing tamper-proof work stoppage prescription forms, which will become mandatory from June 2025. This measure aims to prevent fraudulent activities and ensure that prescription forms are authentic and accurately reflect the medical needs of patients.
The Role of Unions and Social Partners
Unions, such as Unsa, have emphasized the need to address the root causes of the problem, including more serious and numerous illnesses, longer careers, and increasing psychosocial risks. They argue that stigmatizing the sick is not the solution and that it is essential to recognize that the work environment itself may be “sick” and require reform.
Conclusion
The unsustainable growth of expenditure linked to work stoppages is a pressing issue that demands immediate attention from politicians, social partners, and other stakeholders. By working together to identify and address the root causes of the problem, we can create a fairer, more equitable, and sustainable healthcare system that benefits everyone.
Striking Workers and Health Insurance: A Separate but Related Issue
In a related development, the Striking Workers Healthcare Protection Act has been proposed to require employers to continue providing health insurance to workers on strike for fair
The Sustainable Development Goals Report 2023
Unsustainable Growth in Health Expenditure Linked to Work Stoppages: A Call to Action
As the budgetary choices for 2025 are being prepared, Health Insurance is warning of the “unsustainable” growth in expenditure linked to work stoppages, and is calling on politicians and social partners to address the issue. According to the director of the National Health Insurance Fund, Thomas Fatôme, expenditure on compensation for people on sick leave was once again on the rise (+8%, including work accidents and occupational diseases) in the first half of 2024, and could “exceed 17 billion euros” by the end of the year [[3]].
The growth in health expenditure is a concern globally, with current health expenditure (CHE) being a significant portion of a country’s GDP. In OECD countries, CHE accounts for around 9% of GDP on average [[1]]. In poor countries with a per capita GDP of less than 500 US$ per year, donor funding accounts for approximately 45 percent of health expenditure, on average [[2]].
In the European Union, current healthcare expenditure was €1,592 billion in 2021, with variations in healthcare financing, functions, and providers across member states [[3]]. The rise in health expenditure linked to work stoppages is a complex issue, influenced by demographic factors such as an aging population, economic factors like increases in average salaries or minimum wages, and other factors yet to be determined.
To address this issue, Health Insurance is calling for a comprehensive approach, involving all stakeholders, including the government, Parliament, social partners, and others. The aim is to make the system fairer, more equitable, more readable, and more sustainable. Health Insurance will “relaunch” and “expand” the range of actions aimed at policyholders, businesses, and prescribers, which in 2023 allowed it to cut 200 million euros from the increase in expenditure.
The Cnam will contact social security beneficiaries who have been on sick leave for more than 18 months to check whether their sick leave is still justified or if it can be adapted with therapeutic part-time work or an organized return to work. Some insured persons will be reminded of the rules by mail, and the Cnam will contact general practitioners with high prescription levels to improve practices and reduce expenses.
Health Insurance is also rolling out tamper-proof work stoppage prescription forms, which will become mandatory from June 2025. The organization will visit companies with high absenteeism to check whether they are creating conditions that lead to work stoppages or accidents.
Unions have cautioned against stigmatizing the sick and emphasized the need to tackle the root causes of health expenditure growth, including more serious and numerous illnesses, longer careers with the increase in retirement age, and constantly increasing psychosocial risks.
The unsustainable growth in health expenditure linked to work stoppages is a pressing issue that requires a collaborative approach from all stakeholders. By addressing the root causes of this growth, policymakers, social partners, and healthcare professionals can work together to create a more sustainable and equitable healthcare system.
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