Nationwide reimbursement for prescription sports activities for patients with certain conditions was expected to be included in the healthcare budget for 2024 - but is not yet in the draft document.
Trials into these activities have been undertaken and found to be effective with significant reduction in medicines taken by participants and improvements to balance and mobility.
The projet de loi de financement de la Sécurité sociale was published yesterday (Wednesday, September 27).
Expectations were high that the reimbursement of sports sessions for patients with cancer, diabetes and other conditions will be expanded nationally.
However, there was no sign of this in the draft.
The plan ties in with President Emmanuel Macron’s aim to promote sport and physical activity as France prepares to host the Olympic and Paralympic Games in 2024.
Sports sessions have been reimbursed since 2016 in some areas, for example Strasbourg and the wider Grand Est region, with doctors able to prescribe sport sessions to people with chronic diseases.
However, they are not reimbursed on a national level so overall the take-up is currently low.
Sport for health on prescription
Sports sessions on prescription - known as ‘Sport santé sur ordonnance’ (SSSO - sport for health on prescription) was launched in Strasbourg in 2012.
At first the sessions were reserved for adults with a chronic disease, including cancer, cardiovascular issues, diabetes, obesity, or high blood pressure.
Strasbourg has a higher than average rate in France for cardiovascular disease, obesity and mortality.
The sessions have since been rolled out to include fragile elderly people, those suffering with psychiatric problems, people with long Covid, pregnant women and young mothers.
In all, around 5,000 residents are reported to currently benefit from reimbursed SSSO sessions.
“Each week, 1,000 people go to around 100 activity sessions,” said Matthieu Jung from Strasbourg’s Maison Sport Santé in Le Monde.
Since 2014, 1,000 children have been signed up to the scheme to help them combat obesity and weight issues.
How does the prescription work?
When a patient has been given a prescription, they first undertake a medical sports evaluation, including a test to see how far they can walk in six minutes.
The patient then chooses a type of sport from one of several available, including yoga and swimming, having 12 sessions over three months. The sessions are free for the first year, and then priced on a sliding scale in line with income for the second year.
Since 2018, 17,402 patients in the Grand-Est region have benefitted from the sessions.
Dr Arielle Brunner, promotion director for the region’s health agency, Agence Régionale de Santé, believes that 20% to 25% of the local population could benefit.
A trial carried out by the Assurance maladie - health insurance scheme - compared 172 people taking part in the programme against control participants who were not taking part.
The scores of the 172 SSSO participants in walking and balancing tests increased significantly - and their healthcare use dropped 35% over 18 months.
There was a notable fall in the use of medicines among those taking part, while similar use increased by 12% in the control group.
Further studies conducted by sociologists at the University of Strasbourg showed that the measure especially helped those with low incomes.
Around 60% of SSOS participants are on the minimum wage or collecting benefits.
Although doctors have technically been able to prescribe sports sessions since 2016 for those with chronic diseases, in practice few doctors are doing so.
This is despite the ‘chronic diseases’ definition having been expanded in 2022 to include those considered to be losing mobility.
Some top-up private health insurers reimburse a certain number of sessions, but those without top-up insurance may miss out.
Le Monde estimated that inactivity costs France €140 billion per year, with an inactive person aged 20-39 years costing the country €843, and someone aged 40 to 74 costing as much as €23,277.
The calculation was based on figures from the World Health Organisation (WHO) and several official French health bodies as well as the Lancet medical journal.
The French health insurance system has said it could cover SSOS for all patients in France with cancer or diabetes. This rollout could cover around seven million people, allowing access to two or three sessions a week for three months.
In time more diseases could be covered, depending on the results of local trials.
Prevention and treatment
The many benefits of exercise are well known, both in preventing and treating disease.
Some studies - reported in Le Monde - have found that exercise can significantly reduce tiredness and treatment side effects for cancer patients.
It can also reduce the likelihood of breast cancer relapse by as much as 40% to 60%.
However in France, as in many other countries, levels of sedentariness are considered to be high.
Around 47% of women and 29% of men are physically inactive, according to data from France’s Observatoire national de l’activité physique et de la sédentarité - the national watchdog on physical activity and sedentary levels.
WHO estimates that worldwide, almost 50 million new cases of avoidable chronic diseases will develop annually due to lack of activity if nothing changes.
François Carré, sport cardiologist, told Le Monde that this could result in an extra 150,000 to 200,000 cases in France per year.