The French parliament has officially adopted its healthcare budget for 2024, including measures to cap spending, address medicine shortages, and limit social security fraud.
The budget de la Sécurité sociale, sometimes shortened to the ‘Sécu’ budget, was adopted on December 4 after the Assemblée nationale rejected a motion of no confidence against the government after Prime Minister Elisabeth Borne once again used the controversial article 49.3 to pass the bill.
Read more: What is France’s article 49.3?
There are 113 articles in total, but the major measures include more stringent checks on sick leave and social security fraud, and the enabling of pharmacists to dispense of medicines pill-by-pill (rather than entire boxes) in the event of shortages.
Here are the 10 key measures and aims.
1. Savings of €3.5 billion
The government plans to save billions across the healthcare sector, including €600 million on hospital spending, €1.3 billion on healthcare products and medicine prices, €300 million on outpatient care (particularly on analysis laboratories), and €1.25 billion on ‘making professionals and patients more responsible’, or ‘self-sufficient’.
Despite this, however, health insurance expenditure is still set to represent 8.7% of GDP in 2024, compared with 8.2% before the Covid-19 health crisis.
2. More measures against social security fraud
Also on the government’s list is the ‘under-declaration’ of turnover by micro-entrepreneurs employed by digital platforms.
This is estimated to equal a loss of revenue of €800 million. By 2027 platforms will be required to deduct these contributions directly, the government has said. The bill will also introduce the offences of 00‘incitement to social fraud’ as well as the ‘promotion and facilitation of fraud’.
3. Single-pill dispensing in the event of shortages
In the event that a medicine is in short supply, pharmacists may be required to dispense single-dose, or specific tablet quantities, of a medicine. Pharmacists will have to dispense ‘the appropriate quantity’ according to the patient's prescription, rather than a whole box.
The government may also make it compulsory to carry out a test rapide d'orientation diagnostique (TROD, rapid diagnostic test) when dispensing certain antibiotics, to ensure that antibiotics are only prescribed when appropriate.
On the other hand, testing will also mean that pharmacists will be able to check for issues such as strep throat and cystitis, and dispense antibiotics for these conditions without a doctor's prescription.
4. Tighter controls on sick leave
Tighter rules on sick leave will mean that companies will have the power to appoint their own examining doctor, who will be authorised to suspend the payment of benefits to the patient on sick leave if they consider the absence to be unjustified. The Assurance maladie may also carry out a second examination.
Sick leave signed off via teleconsultation (video call) will be limited to three days at a time, except for those prescribed by the company’s own appointed doctor.
5. ‘Temporary status’ for therapeutic cannabis
Therapeutic cannabis - cannabis that is used to help treat health conditions, such as chronic pain - has been granted ‘temporary status’ for five years, pending a decision from European authorities on its marketing authorisation.
Some European countries have already authorised medical cannabis to calm pain and anxiety for some patients. However, it was previously only authorised in France as part of an experiment, which had been due to end on March 26, 2024.
6. More widespread use of shared medical transport
The new bill states that patients who refuse to share a health transport service (light medical vehicle or approved taxi) with another patient without a valid medical reason will have to pay in advance.
They will also only be reimbursed on the basis of the price of shared transport, rather than a solo service.
7. Different sources of hospital funding
The new budget is set to introduce two new funding methods for hospitals. One will be based on ‘public health objectives’ and the other on ‘specific missions’ (not yet revealed).
This reform will not begin to apply in full until January 1, 2025.
8. Reimbursed physical activity sessions for cancer patients
Cancer patients will benefit from reimbursed physical activity sessions to help support their treatment journey. The scheme will initially be trialled for two years, on an experimental basis.
9. Menstrual underwear and cups reimbursed
Reusable sanitary protection (menstrual pants and menstrual cups) will now be reimbursed for women under the age of 26, and all women covered by the Complémentaire santé solidaire scheme.
Condoms will also be free for all insured persons under the age of 26.
10. Systematic screening for pregnant women
Pregnant women will now be systematically screened for cytomegalovirus (CMV).This is a virus that can affect foetal development.
In addition, a three-year trial of a care pathway dedicated to post-partum depression - a serious condition that can range from ‘baby blues’ to severe psychosis - has also been added.