Good news for French healthcare

Independent state report finds system is still one of best and will soon balance its books

20 January 2017

France is making significant progress in balancing the books of its state healthcare system while maintaining good reimbursement rates, a report by the leading public finance watchdog shows.

The Cour des Comptes, in its annual report, says France is successfully moving towards closing up the so-called trou de la Sécu (‘social security gap’). This refers to the formerly ballooning annual social security deficit – the difference between contributions coming in and money being paid out.

France is also making headway with clearing the underlying dette sociale (accumulated social security system debt), which had been rising due to the annual deficit.

Refering to 2015 the report says: “After 13 years of uninterrupted increases, the debt started to shrink in 2015, settling at €156.4billion [compared to €161bn at the end of 2014]”. It says a target of 2024 for paying off all debt is likely to be met.

The Cour des Comptes also notes that compared to other EU countries the French healthcare system reimburses an especially large range of treatments and France is the country where people have the least costs left to pay following reimbursements, after the Netherlands.

This comes as Health Minister Marisol Touraine presented a draft social security budget for 2017 aiming to reduce the deficit of the régime général (the main branches of social security: health, family, pensions, work-related accidents/illnesses) to just €400million in 2017. It is expected to be €3.4bn this year. “We’re a hair’s breadth away [from closing the ‘gap’] …we have saved the Sécu,” she said.

“This presidency will go down in history for the ending of social security deficits,” she added (the régime général annual deficit was €23.9billion in 2010).

The improvements follow pension reforms in 2010 and 2013 plus efficiency measures in health reimbursements, such as greater use of generic medicines. But also – the Cour des Comptes said – reflected a “gradual upturn in the economy”, with more money paid in salaries meaning more cotisations are received to fund the system.

The predicted €400million does not include the deficit of the Fonds de Solidarité Vieillesse, the part of social security that gives ‘solidarity’ to the needy regardless of their contributions. This covers paying pension contributions for the unemployed and ASPA for elderly people on low incomes – however France is on target for complete balancing by 2019, the government predicts.

The Cour des Comptes report noted that the deficit of the régime général dropped €2.6billion in 2014-15 after a similar drop in 2013-2014, however further savings had to be made to maintain the momentum.
“After 25 years of continual deficit – a whole generation – coming back as fast as possible to equilibrium for the state health insurance sector is top priority.” It called on the government to “keep up efforts”.
“In 2016 we may have a reduction of the same size as in 2015, but return to equilibrium before 2020 is not certain yet,” it said.

To meet the targets, €4bn in health spending savings are planned in 2017 with measures including lowering prices of some medicines and new levies on the pharmaceutical industry.
The government is also calling for greater efficiency in hospitals and more use of out-patient care, including for surgery.

One challenge next year, however, will be planned increases in doctors’ fees, with GPs’ consultations to rise from €23 to €25 in May (meaning extra reimbursement costs, as reimbursement percentages stay the same).
The social security budget for next year also allows for some new income streams, including from renting out your home on Airbnb or renting out private cars, with plans to clarify the rules on income ceilings at which social charges become payable on these. Also planned are a 15% increase in the price of rolling tobacco and a new tax on the turnover of tobacco distribution firms.

Paying off the accumulated social security debt is the responsibility of an agency called CADES. The Contri­bution pour le Remboursement de la Dette Sociale (CRDS) social charge goes towards this.

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