Health: the Court of Auditors calls for a more efficient and economical organization of care

In a report presented on Wednesday, the financial magistrates regret that Medicare does not carry out structural reforms that would allow it to save money and ultimately no longer increase the social debt. Even if it means making patients pay a little more.

Pierre Moscovici, who took the head of the Court of Auditors, presents this Wednesday the annual report on the budget of Social Security.

In the role of the grumpy who does not want to manufacture debt at a time when everyone is enjoying it: the Court of Auditors. In its report on the application of social security financing laws, published on Wednesday, the institution chaired by Pierre Moscovici regrets that Medicare does not carry out structural reforms that would allow it to save money and ultimately to no longer increase the social debt. Even if it means making patients pay a little more.

Given the government’s forecasts, calculates the Court, Social Security will produce by 2024 at least 50 billion more deficits than what the legislator has planned to transfer to the Social Debt Redemption Fund, i.e. 136 Billions of Euro’s. It is therefore necessary to review the multi-year trajectory and reform the branch with the greatest deficit, Medicare, insist the financial magistrates.

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The latter do not tackle the 13.7 billion euros of exceptional spending 2020-2021 aimed at tackling the coronavirus, but they note that the “Health Segur” will cost an additional 11 billion euros in 2022. One effort to reinvest and revalue salaries in the hospital which should have “In return for the reorganization of the healthcare offer”, they write.

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The example of the Old Age and Family branches

According to them, Medicare has been wasting public money for years by preferring to cut budgets here and there rather than improving the relevance of care. “For the health sector, the measures have not resulted from a structural action on the underlying foundations of health spending, but from an essentially financial and short-term regulation bearing only, and in a variable manner, on professionals and establishments providing care ”, judge the Court.

Despite a “Tight annual financial regulation”, the French benefit from a “Very high level of social security coverage of health care costs”, she emphasizes. Since 2014, the government has refrained from setting up new deductibles or delisting.

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The magistrates give as examples the old-age insurance and the family branch, which have been able to reform in depth … by requiring efforts from the insured. Thus, without the gradual increase in the retirement age, the indexation of pensions to inflation, and the drop in the return on contributions since 1993, pensions would represent 19% of GDP and not 14%. Likewise, the reduction in family allowances for well-off families has made it possible to curb deficits and finance new aid for the most deprived.

Sources of efficiency

However, the Court does not provide a kit solution, and does not recommend modulating health benefits according to income. On the other hand, as every year, it describes a few sources of effective care.

Thus, the regional hospital groups set up in 2016 do indeed save money, but are sometimes too small, and therefore cannot compensate for the shortage of doctors because they cannot offer a wide range of care.

Regarding the 11 billion hospital allocations (over and above the resources linked to the activity), in particular those under missions of general interest and regional funds, the Court calls for the interventions of the regional health agencies to be disentangled from those of the Ministry of Health. The “Overlaps” envelopes and central administration management instructions “Do not allow regional health agencies to orient funding based on an assessment of needs as close as possible to the field”.

Finally, insists the Court, it is necessary to contain the increase of 4% per year in the cost of medical devices, a category reimbursed to the tune of 15 billion euros which goes from the dressing to the medical bed.